Update on HIV/AIDS: How Close Are We to a Cure?

When the HIV/AIDS epidemic officially began in 1981, a positive diagnosis was a death sentence. However, today an estimated 1.1 million people are living with HIV in the US, and thanks to modern treatment, are living longer and happier lives than ever. Although a cure has still yet to be found for the disease, the scientific community has made remarkable strides toward reaching that goal over the last 33 years.

History

When an increasing number of Kaposi’s sarcoma (KS) cases began showing up in young gay men in 1981 in New York, doctors were baffled because KS, a rare form of a relatively benign cancer, tended to only occur in older people. Around the same time, there was an increase in the number of the rare lung infection Pneumocystis carinii pneumonia (PCP) in California and New York. By June of that year, the CDC published a report of 5 PCP cases in young, previously healthy gay men in Los Angeles. All the men had other unusual infections, indicating that their immune systems were not working well, and 2 died before the report was even published. This report is considered the first official reporting of the AIDS epidemic. Within days, doctors from across the US flooded the CDC with reports of similar cases. By the end of the year, there were a total of 270 reported cases of severe immune deficiency among gay men, 121 of whom died.

At first, the epidemic was believed to be exclusive to the gay community. An article that ran in the New York Times on July 31, 1981 quoted a doctor stating, “The best evidence against contagion is that no cases have been reported to date outside the homosexual community or in women.” Yet, by December it was clear that the disease affected other population groups, when cases of PCP began popping up in intravenous drug users. Despite this knowledge, some still associated the disease with its initial occurrence in gay men, calling it GRID (gay-related immune deficiency). But the disease kept appearing in different populations at an alarming rate. The acronym AIDS (acquired immune deficiency syndrome) was suggested at a meeting in Washington, DC in July 1982 and the disease was defined as such by the CDC in September of that year.

Modern Advancements

Today, about 50,000 people in the US get infected with HIV each year and about 35.3 million people around the world are living with HIV altogether. The number is staggering, but much advancement has been made in conquering the disease.

Timothy Ray Brown

It is sometimes forgotten than a man named Timothy Ray Brown was actually functionally cured of HIV in 2008. More famously known as “The Berlin Patient,” Brown was diagnosed in 1995 and he soon after began taking anti-HIV drugs, or antiretroviral therapy, which keeps the virus at bay. In 2006, he was diagnosed with acute myeloid leukemia, a condition deemed unrelated because HIV RNA was not detectable in the patient. Brown was given chemotherapy, but the effects were toxic and he had to stop taking the antiviral medication. However, this resulted in the rebound of viral replication and he was put back on the antiviral drugs. A few months later, the cancer returned. Brown’s doctors then decided to go forward with an experimental procedure to see if they could fight off the HIV and cancer at the same time. The treatment involved receiving 2 stem cell transplants from an unrelated donor, but the donor possessed a unique mutation. Around 1% of the Caucasian population has a mutation that makes them immune to HIV infection. This donor was a part of the 1%. After the transplant, tests showed that Brown was HIV negative. He stopped taking the antiretroviral medication and he hasn’t taken it since.

Brown has been the only person in history to be “functionally cured” of the disease. Doctors are reluctant to use the word “cure” because HIV tends to hide away in cells, replicating at very low levels that aren’t picked up by the immune system. Many are worried that this is the case for Brown and that he is not truly cured, but that the disease is just in hiding. Regardless, Brown’s successful procedure was a triumph in the fight against HIV and AIDS. However, the procedure is not applicable to the majority of people. Stem cell transplantation involves destroying the patient’s immune system and often results in death. It is only used as a last resort.

A Possible New Cure

The fight for the cure of HIV/AIDS only gets more aggressive as we learn more about the disease. Inspired by the treatment of Timothy Ray Brown, researchers at the Harvard Stem Cell Institute have developed a new possible method to remove from blood stem cells the biological receptor that helps host the HIV virus, CCR5. The procedure would modify the CCR5 receptor to be made resistant to HIV and then transplanted back into the patient. “HIV uses the CCR5 receptor to enter T-cells,” researcher Derrick J. Rossi said. “If successful, the gene therapy treatment we propose might accomplish the same thing as the transplant of cells into Timothy Ray Brown, only better because it would be the patient’s own cells that would be made resistant to HIV and then transplanted back to ‘cure’ them of AIDS.” The benefit of modifying a patient’s own stem cells is the fact that they are guaranteed matches. The researchers say that their work could be ready for human trials in about 5 years or sooner.

Truvada

A pill called Truvada doesn’t treat HIV (at least if used by itself), but instead greatly reduces the risk of contracting the virus. According to the CDC, the pill, which has to be taken once daily consistently, has shown to be effective in reducing the risk of HIV infection in people who are at high risk by up to 92%. Truvada contains tenofovir and emtricitabine, which are both used in combination with other drugs to treat HIV. When the pill is taken by an individual who is HIV negative, it keeps the virus from establishing a permanent infection when someone is exposed to the virus. While not a cure, Truvada is the first form of HIV prevention since condoms.

HIV/AIDS and the Young Generation

Although huge advancements are being made in the fight against HIV and AIDS, there is a concern that the younger generation is not taking the disease seriously. Those who were not yet born to see the horrors of the disease when it first broke out in the 1980s may not view HIV as such a bad disease, especially since more people than ever are living comfortable lives after contracting it. “In the 80s and early 90s, people spent a lot of time going to hospitals, funerals, and wakes,” said Larry Kessler, program director at the Boston Living Center, a nonprofit that is New England’s largest community center for those with HIV/AIDS. Andrew Sullivan, a prominent political columnist and blogger, who is HIV positive, also expressed similar views: “The young generation has fewer psychological resources or experiences with HIV to grapple with the whole issue of getting infected.”

This lax view of the disease may be the reason why, according to a report by the CDC, only 30% of Americans with HIV had the virus under control in 2011. Among approximately 840,000 people who had not reached viral suppression, 66% had been diagnosed but were not practicing active treatment. The study also showed that viral suppression increased with age; younger adults were much less likely to have HIV under control versus older age groups. The study emphasized the importance of making sure those infected with the virus receive continued care.

The most important weapon against HIV and AIDS is education, and although we have come a long way since 1981, the fight isn’t over yet.

Reference

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