May 9, 2013
One of the best parts of my job is covering HIV cure stories. They offer hope and they serve as amazing examples of human tenacity and the wonders of modern medicine. First there was the case of Timothy Brown, the so-called "Berlin Patient," who underwent a stem cell transplant using donor cells that were resistant to HIV. After almost three decades of the epidemic, his case proved that HIV could be cured.
Then, last year, there was the less reported case of two patients who received stem cell transplants similar to the one Brown received. The donor cells they received were not resistant to HIV, but because the men were on HIV treatment throughout the process, those donor cells were not infected. While both men were still on HIV meds, they showed no traces of HIV in their blood.
Next, at CROI 2013 in Atlanta, we learned about the baby from Mississippi who had been cured after very early treatment. I was present at the press conference where Deborah Persaud, M.D., and four other researchers were providing a preview of their respective study presentations. One would hardly know there were other studies, because all the questions were directed at Persaud about the cured baby. While the media coverage may have been a little overboard, it did put HIV in the national spotlight and gave people hope.
Shortly after, there were more results from the VISCONTI study, which followed 14 patients who had started treatment during acute infection. The patients continued treatment for at least a year before stopping. Surprisingly, they were able to control the virus and have undetectable viral loads without meds. While technically they are still HIV positive, they are "functionally cured," because their HIV reservoirs are much smaller and they don't need to take meds.
Then, last month, came the news about a 12-year-old boy who received a stem cell transplant using HIV-resistant donor cells to treat his HIV and leukemia. Sound familiar? It should, because it's the same procedure Timothy Brown underwent, though with one key difference. Instead of using bone marrow, the doctors used umbilical cord blood, which is easier to match. The procedure went well and we're waiting to see if the boy is cured.
Finally, last week, there were news reports about a Danish study testing panobinostat, an HDAC inhibitor, in 15 patients in an attempt to flush HIV out of latently infected CD4 cells that act as viral reservoirs. The researchers said they would have preliminary results within months, adding that the early signs were promising. However, the original news report of the study misinterpreted this as a promise of a cure within months, and the rest of the media ran with it.
David Evans of Project Inform wrote a great piece that demystifies all the media hype, where he explained:
Last week the London Daily Telegraph ran a story on this new compound, but claimed that a cure was just around the corner. The reporter apparently misquoted the researcher and overly hyped what he'd been told. The reporter has since toned down his piece and changed the headline due to pressure from a prominent activist in England and likely due in part to a piece the researchers themselves felt compelled to post to refute the article's claims. Unfortunately, the press outside of London grabbed hold and has been retreading the original uncorrected story since then.
Overall, the method of using HDAC inhibitors to awaken HIV reservoirs is still being studied in early stages of clinical trials. Even if they work, they need to be coupled with other strategies to then eradicate or at least reduce the reservoirs. On the other hand, stem cell transplants and very early treatment aren't practical or applicable for everybody, but these cases are the stepping stones that lead to medical advances that could be practical cures. I look forward to the day when a "functional cure" is old news. Until then, keep the HIV cure research coming.
Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.
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