HIV Testing Remains Vital Despite Second "Cured" HIV Patient
A second patient presumably cured of HIV—the virus that can cause AIDS if untreated—has had significant coverage in the media recently. While headlines seem to declare the so-called “London patient” cured, scientists are describing this individual’s case as a long-term remission. They caution that the treatment is not an option for most people because of its risk and that a true cure is still a long way off.
The London patient with HIV also had a form of blood cancer called Hodgkin lymphoma that was not responding to chemotherapy. To treat the cancer, his healthcare team, led by Dr. Ravindra Gupta, a virologist at University College London, performed a bone marrow transplant. The transplant replaced the patient’s bone marrow (the part of the body that produces blood cells) with marrow from a healthy donor.
This donor marrow was specifically chosen because the cells had two copies of an uncommon mutation in the CCR5 gene. This gene codes for proteins on the surface of white blood cells (WBCs) to which HIV attaches when infecting cells. The mutation results in WBCs that are less prone to HIV infection.
HIV primarily infects and kills WBCs called T-helper cells that help protect against various infections. Untreated, HIV can progress, leading to serious infections and eventually to the development of AIDS. (Read the article on HIV Infection and AIDS.)
After a successful bone marrow transplant, the London patient not only appeared cured of lymphoma, his new WBCs now had the donor’s CCR5 mutation, and laboratory testing could no longer detect HIV in his blood. Sixteen months after the transplant, the London patient stopped taking the antiretroviral drugs that suppressed HIV replication. Two months later, laboratory testing still demonstrated no signs of HIV in the patient’s blood.
In a press release about the London patient, Dr. Gupta said “It’s not yet possible to say whether the patient has been cured. This can only be demonstrated if the patient’s blood remains HIV free for longer.”
While this news is remarkable, it is unlikely that bone marrow transplants will become a common-place or practical treatment for people with HIV. Success of the bone marrow transplant in this patient, however, may provide important information for researchers working to find a cure.
For now, many public health experts continue to focus on providing education and healthcare access to people with HIV and at risk for HIV infection. One of the most important things people can do – especially people at high risk for contracting the virus – is to be tested and know their HIV status. About 1 in 7 people in the U.S. with HIV are unaware that they have it. People can help prevent spread of HIV by learning their status and modifying behavior to avoid exposing others to the virus. Several options are available for getting tested, ranging from at-home saliva tests to blood tests done in a clinic or laboratory. (For more details, read HIV Antibody and HIV Antigen (p24).)
Several health organizations recommend that anyone between the ages of 13 and 64 as well as pregnant women get tested for HIV at least once. People at risk should consider frequent (e.g., annual) screening. You may fall into this group if you:
- Had unprotected sex with more than one partner since the last HIV test
- Are a man who has had sexual contact with another man
- Use street drugs by injection, especially when sharing needles or other equipment
- Have exchanged sex for drugs or money
- Have an HIV-positive sex partner
- Have had sex with anyone who falls into one of the categories listed above or are uncertain about your sexual partner’s risk behaviors
Early diagnosis leads to timely treatment with antiretroviral drugs that, if taken regularly, can reduce the amount of virus present (viral loads) to nearly undetectable levels. Effective treatment decreases the risk of progression to AIDS and reduces the risk of passing HIV on to someone else. For people who have a greater risk for contracting HIV, a daily pre-exposure prophylaxis (PrEP) pill can help prevent infection.
Today, HIV is no longer considered fatal. Until a true cure is found, fighting the stigma of HIV and encouraging routine HIV screening and timely treatment continue to be the most effective strategies.
(March 5, 2019) Gupta, R.K. et al. HIV-1 remission following CCR5Δ32/ Δ32 hematopoietic stem-cell transplantation. Nature. DOI: 10.1038/s41586-019-1027-4. Available online at https://www.nature.com/articles/s41586-019-1027-4. Accessed on March 20, 2019.
(March 4, 2019) Mandavilli, A. H.I.V. is reported cured in a second patient, a milestone in the global AIDS epidemic. The New York Times. Available online at https://www.nytimes.com/2019/03/04/health/aids-cure-london-patient.html. Accessed on March 20, 2019.
(March 9, 2019) O’Donnell, J. and Alltucker, K. Doctors might have found a cure for HIV. But is it worse than the disease? USA Today. Available online at https://www.usatoday.com/story/news/health/2019/03/08/hiv-aids-cure-stem-cell-bone-marrow-transplant-london-patient/3083976002/. Accessed on March 20, 2019.
Warren, M. News: Second patient free of HIV after stem-cell therapy. Nature. Available online at https://www.nature.com/articles/d41586-019-00798-3. Accessed on March 20, 2019.