A cure for HIV? Case studies show feasible treatments not yet realised

The treatment involves destroying a person's own immune system with high doses of chemotherapy or radiation. Then the patient receives a transplant of new stem cells from either themselves or a donor.

Business Standard : This week a team of scientists and physicians from the U.K. published news of a second HIV positive man, in London, who is in long-term (18-month) HIV remission after undergoing treatment for Hodgkins lymphoma. The unexpected success has launched a new round of discussion about a potential cure for HIV.

Since 2008, scientists have been trying to replicate the treatment that cured the “Berlin patient” of HIV. At the time, many in the field of HIV research were excited to learn that this man, who tested positive for the human immunodeficiency virus in Berlin and had recently undergone treatment for acute myeloid leukemia, appeared to have been cured of his HIV. Until now, success in replicating that cure has been limited.

What is HIV?

HIV is the virus that causes AIDS. Since the virus was first discovered in the 1980s, more than 75 million people worldwide have been infected with HIV. Today, almost 37 million people live with HIV. Of these, about 1.1 million live in the U.S.

Infection with HIV almost always led to AIDS, which in turn was almost always fatal. The field was revolutionized in 1996 with the introduction of HIV anti-retroviral therapy medications. These drugs halt HIV from replicating and allow an infected person to regain a functioning immune system. These medications are so effective that today a person living with HIV has almost the same life expectancy of someone without HIV infection. However, these medications must be taken every day, have multiple distressing side effects, and can cost thousands of dollars each month.

Yet even with this life-extending treatment, a functional HIV cure, defined as when someone with HIV no longer tests positive for the virus and does not need to take these medications, has remained elusive.

The ‘cure’ treatment

All of that seemed to change when in 2008 at the Conference on Retrovirus and Opportunistic Infections in Boston, Massachusetts, the news broke of the Berlin patient, named Timothy Ray Brown, who seemed to have been cured of his HIV. In order to achieve that serendipitous “cure,” Brown had to undergo aggressive treatment for his acute myeloid leukemia that involved two hematopoietic stem cell transplantations – in which a patient’s bone marrow is damaged – and full body irradiation.

This complex treatment involves destroying a person’s own immune system with high doses of chemotherapy or radiation. Then the patient receives a transplant of new stem cells from either themselves or a donor.

This is a difficult treatment that carries a high risk of infection and other complications, such as graft-versus-host disease, blood clots and liver disease.

Fighting drug-resistant TB: What India can learn from S Africa's success

If India follows new World Health Organization (WHO) guidelines released in August 2018 and reiterated on December 21, 2018, other drug-resistant TB patients will not have to struggle similarly.

In July 2017, 40-year-old Noludwe Mabandlela, a single mother of two, collapsed at home. This ended up saving her life. The ambulance that responded took Mabandlela to the nearest government community health centre, where she was diagnosed with multi-drug resistant tuberculosis (MDR-TB). As the name suggests, first-line drugs such as rifampicin used to treat the more common, drug-sensitive TB don’t work on MDR-TB, from which patients have an increased risk of death and from which they take two years to recover, compared to six months in conventional TB.

Forty-year-old Noludwe Mabandlela, a single mother of two, received new TB drugs bedaquiline and delamanid for multi drug-resistant TB and, a year later, now hopes to make a full recovery. Here, she shows a photo of herself before she contracted MDR-TB.

Until then, an ailing Mabandlela--who lives in Khayelitsha, South Africa’s largest township, or informal settlement, 30 km southeast of Cape Town--had been going to a private hospital, where she was not tested for TB. Government health staff started Mabandlela on MDR-TB treatment, which included taking injectable drugs for six months. She developed side-effects from the drugs, including numbness in her feet, hearing loss and kidney impairment.

Mabandlela was then put on bedaquiline--the first new TB drug developed in nearly 40 years--through the South African department of health’s National TB Control Programme (NTCP). Since 2015, South Africa had started making the drug available in the NTCP for patients with extensively drug-resistant TB (XDR-TB)--the most severe form of MDR-TB--and for patients like Mabandlela who developed severe side-effects from MDR-TB drugs.

Mabandlela also received another new TB drug delamanid from international humanitarian aid organisation Medicins Sans Frontieres (MSF), in November 2017. These new drugs are still not commonly accessible--just over 24,000 of the world’s 558,000 MDR-TB patients have received bedaquiline till August 2018, and only 2,020 have received delamanid.

Mabandlela, HIV-positive and a cancer survivor, had almost given up hope as she lay hospitalised for a month. Now, over a year since her treatment began, she hopes to make a full recovery. Her story is a beacon of hope for MDR-TB patients globally.

Till 2014, almost one in two MDR-TB patients in South Africa were not successfully treated, according to a retrospective study of 19,000 patients published in The Lancet Respiratory Medicine journal in July 2018. Two out of 10 MDR-TB patients in the country died during the 18- to 24-month long treatment, the study found.

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