Since the 1980s scientists have been chasing a cure for Aids, the viral immunity deficiency syndrome that affects about 37-million people globally. So it’s ironic that hot on the heels of Rami Malek’s Oscar win for portraying Freddie Mercury, perhaps the most famous person to die of the virus, scientists have reported that “a cure for HIV infection is possible, if difficult”.
Contrary to sensationalist headlines, it isn’t exactly a cure. It’s far too early to use that word, considering that so far there are only two known instances, 12 years apart, in which a patient has achieved “long-term remission”.
The first to achieve this success was called “the Berlin patient”, later identified as Timothy Ray Brown. In 2007 at a conference on retroviruses and opportunistic infections, Dr Gero Hütter reported that after giving Brown a bone-marrow transplant to treat his leukemia it appeared his HIV went into remission, even after he stopped taking antiretroviral medication.
This was largely attributed to the transplant in question having a mutation in the CCR5 protein of the immune cells. This prevents the virus from latching onto and infecting the cells. These are the self-same cells for which Chinese scientist He Jiankui is now facing a possible death sentence after he genetically mutated them in a set of twin embryos towards the end of 2018.
Up until then countless attempts to replicate Brown’s results had proved futile. Many scientists attributed this to the degree of destruction to Brown’s immune system and his near death as a result of harsh, abandoned now, immunosuppressive drugs and complications after the operation. It was thought that almost killing one’s patient for them to survive an infection was a little too extreme to replicate.
However, at 2019’s conference on retroviruses and opportunistic infections, Dr Ravindra Gupta, a virologist at University College London, presented his “London patient”, whose ordeal proved far more manageable.
After receiving a bone marrow transplant from a donor with the CCR5 mutation in May 2016 to treat his Hodgkin’s lymphoma, a normal intake of modern immunosuppressive drugs appears to have done the trick. Since stopping his antiretroviral medication in September 2017 he appears to have remained virus-free.
Furthermore, another subject in Gupta’s study, the “Düsseldorf patient,” has also been off his drugs for four months with no sign of the virus.
“I feel a sense of responsibility to help the doctors understand how it happened so they can develop the science,” the London patient, who wishes to remain anonymous, told The New York Times. “I never thought that there would be a cure during my lifetime.”
The London patient’s enthusiasm for a cure in his lifetime, albeit still naively hopeful, isn’t impossible. As it stands the variables are just too arbitrary — patients have to have the right number of modified cells, in the right bone marrow, with genes that are mutated in a very specific way. There is a huge shortage of bone marrow donors, not to mention those with “just the right stuff” for this type of treatment to be truly scalable. Not to mention that only about 50% of Aids cases use CCR5 for entry, meaning this treatment won’t help the 17.5-million other patients with the virus.
Scientists are unlikely to give up now that this second instance of hope has occurred. Although there is no clear way forward at this stage, there may be a time when scientists could harness and create an army of CCR5 mutated cells that could attack the infection. Or, in a less dodgy move inspired by He, perhaps create a means to inject mutated genes into the body that will seek out all CCR5 receptors and delete them.
This type of research into targeted supercharged immunity, coupled with the leaps and bounds under way in micro-engineering, means scientists may not be far off creating — or printing — specifically modified HIV-immune bone marrow from patients’ cells.
But at this stage we will take whatever we can get. Especially locally, where according to a new study published on February 25 on Nature.com, it would appear that despite the SA government’s best efforts theAids crisis will not be resolved soon.
“SA and Southern Africa fall in the epicentre of the HIV/Aids pandemic. The region is home to [less than] 2% of the world’s population, yet accounts for a third of the global HIV disease burden,” the paper reads.
According to the paper by Eduan Wilkinson and associates, the epidemic growth of the virus in SA has stabilised in recent years with the implementation of several policy changes and campaigns. However, despite the 2016 adoption of UNAids’ 90–90–90 strategy, which aims at having 90% of infected individuals diagnosed by 2020 with 90% of those diagnosed on combination antiretroviral therapy. The final 90 the project speaks of — 90% virological suppression — might not be achievable.
It would appear that all the efforts of giving 3-million HIV-positive South Africans combination therapy by 2015, thus making SA’s national HIV treatment campaign the world’s largest, have rendered some curious results. It would appear that despite these efforts only four out of the 14 subtypes of HIV (clades) decreased in the process.
“Our results demonstrate that interventions do not affect the HIV epidemic universally, with major difference between different clades over time and space.”
Not quite the numbers we were hoping for, and yet a 28% decrease in the virus subtypes is still something. Every little bit helps, as with “London” and “Berlin,” two cures out of millions. Those are small odds, but I’ll take them.
• McKeown is a gadget and tech trend writer.
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