Whenever you see a newspaper headline about a cure for HIV, it's worth treating it with a pinch of salt. That's certainly the case with the latest story, first reported by The Sunday Times of London and repeated in media outlets around the world.
Many people living with HIV desperately want to see a cure for HIV. Millions of other people would be fascinated and encouraged to see such scientific progress. Journalists know this, which is why they so often fall into the trap of writing stories that suggest a cure is just around the corner. The idea fills us with hope, and huge numbers of people will click on the story to find out more.
The mainstream media tends to report these issues in a misleading way or leave out key details that would help people living with HIV understand what the developments mean for them. Important and legitimate scientific studies are misrepresented.
What's the New Story About a Cure?
The headlines tell us "British Scientists on Brink of HIV Cure," "HIV Cure Close After Disease 'Vanishes' From Blood of British Man" and "British Man Becomes the First Patient Cured of HIV."
The reports suggest that the man took an experimental treatment and now the scientists cannot find a trace of HIV in his body. That suggestion is wrong. Here's what really happened.
He was diagnosed within six months of infection and took an intensive treatment regimen -- four antiretrovirals, a drug called vorinostat and two vaccines.
Several months after beginning his treatment, tests can't detect HIV in his blood. In other words, his viral load result is undetectable. This may sound remarkable and astonishing to some journalists, but people with HIV will know that this is exactly the result we expect after several months of antiretroviral therapy.
Remember, this man's treatment includes antiretroviral therapy, the same drugs used by other people living with HIV. He took other, innovative treatments as well, but his antiretroviral therapy alone could be expected to bring his viral load down to an undetectable level.
And, very importantly, he is still taking antiretroviral therapy. Nobody knows what will happen if he ever decides to stop taking his treatment.
What Do We Know About the Study?
The man is taking part in a serious clinical trial that is investigating an innovative approach to treating HIV. Researchers at five leading British universities are conducting it.
The scientists hope their aggressive treatment will eradicate latent reservoirs of HIV in the body. Reservoirs are made up of millions of immune system cells that contain dormant HIV. They persist even when antiretroviral treatment reduces viral load (RNA) to undetectable levels -- but would be re-activated if antiretroviral treatment were stopped.
Around 50 people who have had HIV for less than six months will take part in the study. They will all take an intensive combination of antiretroviral therapy (four drugs, including Isentress [raltegravir]).
In addition, half the participants will be randomly assigned to take the innovative treatments. For one month, they will be given vorinostat, a drug that forces the virus to emerge from hiding places in the body. They will also receive two vaccines that aim to boost the immune system so that it can attack HIV-infected cells. The strategy is called "kick and kill."
Ten months after study participants enter the trial, the researchers will measure levels of HIV DNA in CD4 cells. This will provide an indication of whether the treatment has had an impact on the HIV reservoir.
The unnamed man who has been the focus of the media attention is simply the first study participant to have completed the experimental therapy. The researchers report that the treatment was safe for him. In a brief statement they released on Oct. 3, the researchers themselves note that results of the study will not be reported until 2018, and that until then, "We cannot yet state whether any individual has responded to the intervention or been cured."
Questions and Answers
- What about the other people taking part in the study?
Only 39 of about 50 participants have been recruited so far. We don't know anything else about the other participants.
- Do tests show that this man's viral reservoir has been eliminated?
We don't know; the scientists will only report this information when the trial is completed in 2018.
- How would we know that someone is cured of HIV?
Antiretroviral therapy would have to be stopped and the person monitored for several years. Researchers would check to confirm that either that there was no trace of HIV in any cells or the person's immune system could keep HIV under control without treatment.
- Will people in this trial stop their antiretroviral therapy?
This is not part of the study. The researchers may explore this option in the future but are not recommending it for now.
- Has anything like this been tried before?
Slightly different "kick and kill" approaches have been tried in other studies. And there have been examples of people taking intensive treatment very soon after infection, continuing with it for several years, then stopping treatment and remaining undetectable.
- Has anyone been cured of HIV?
To date, there is only one confirmed case of an HIV cure. Timothy Ray Brown, who needed treatment for advanced leukemia, received a never-before-attempted stem cell transplant in which the donor had a rare mutation making him essentially immune to most forms of HIV.