Is There A Cure For HIV/AIDS?
If you’ve been paying attention to the news lately, you’ve likely seen a few headlines about HIV/AIDS—but unlike 30 years ago, it’s been mostly good news. Thanks to developments from doctors, scientists, and researchers, the world is inching closer and closer to finding a cure to HIV/AIDS. However, despite the incredible progress, the fight to end AIDS is still in jeopardy.
So, is there a cure? The answer isn’t a simple yes or no. Here’s what you need to know about the “cure” to HIV/AIDS:
The Real Status on the “Cure”
Let’s be clear on what the latest cases of reported “cures” mean. Scientists are careful to describe the current “cure” as a case of “long term viral remission,” meaning that the HIV virus is suppressed, but still present in the body. The patients currently reported as “cured” are off antiretroviral treatment (ARVs) and not experiencing any symptoms.
The Berlin Patient
Talk of the first known, sustained cure started with Timothy Brown, known as the “Berlin Patient.”
Brown was diagnosed with HIV in 1995 and in 2007, his HIV went into remission after undergoing a bone marrow stem cell transplant.
Prior to his transplant, Brown had been diagnosed with leukemia. His body wasn’t responding to aggressive chemotherapy, so his doctor came up with the novel idea to swap his vulnerable tissue with healthy stem cells from a donor carrying a rare CCR5 mutation called CCR5-delta 32. CCR5 is a protein receptor that HIV uses as an entry point to the immune system. If someone carries the CCR5-delta 32 mutation, this entry point is blocked off, making it essentially impossible for the carrier to be infected with HIV. Only a very small population of the world has this mutation.
After finding the right donor with this mutation, Brown received the transplant and then stopped taking his ARVs. Brown was observed to see if his HIV would resurge, and after a year, his doctor deemed him HIV-free. In February 2009, the final results were published in The New England Journal of Medicine.
Up until he passed away from unrelated recurring Leukemia in September 2020, Brown remained is still off HIV treatment and continued to show no signs of the virus.
The London Patient
Over the next decade, similar attempts to replicate Brown’s results failed—that was until Adam Castillejo, known only as the “London Patient” in 2019.
Castillejo was diagnosed with HIV in 2003, and then with advanced Hodgkin’s lymphoma in 2012. Like Brown, his body resisted chemotherapy, and as a result, his doctors recommended a stem cell transplant from a donor with the CCR5 mutation, which was conducted in 2016.
After observing him for 18 months, scientists declared Castillejo to be HIV-free. In March 2019, the final results of the “London Patient” were published in the science journal Nature and made front-page news with headlines like “HIV is Reported Cured in a Second Patient.” A year later, in March 2020, Adam Castillejo revealed his identity for the first time.
The First Living HIV+ Organ Donor
A few weeks after word was out on the success of the London Patient, the world received more hopeful news.
Nina Martinez became the world’s first living HIV-positive person to donate an organ to an HIV-positive recipient, giving the anonymous patient one of her kidneys. Until recently, the medical world considered it unsafe for someone with HIV to live with only one kidney, but thanks to ARVs, those with HIV can be organ donors without the past fear of complications.
The CRISPR Method
Flash forward a few months to July 2019, when researchers announced another major breakthrough. Scientists from Temple University and the University of Nebraska Medical Center were able to successfully eliminate HIV in living mice for the first time.
Using a super form of antiretroviral therapy, called LASER, and a gene-editing technology known as CRISPR, these scientists were able to eliminate HIV from the DNA of 9 mice. After treating the mice with LASER, researchers used CRISPR to erase any remaining HIV DNA from their bodies.
These results are the first to prove that removing HIV in living animals is in fact possible. Next up, researchers are looking to replicate this success in primates.
THE SÃO PAULO PATIENT
Almost exactly a year later, in July 2020, researchers from Brazil announced a third person who had been reportedly cured of HIV--but for the first time, without the risks of a stem cell transplant. In this case, the patient was treated for 48 weeks with an intensive experimental combination of AIDS drugs: a base of antiretroviral therapy, which was boosted with additional antiretrovirals, plus nicotinamide, a form of vitamin B3. After 15 months off of ARVs, his HIV DNA in cells and his HIV antibody test remained negative and his doctors declared him “functionally cured” of the virus.
What It All Means
All of these results are incredibly hopeful. They show that new approaches to HIV treatment are becoming increasingly effective and that researchers are slowly getting closer to finding a true cure.
That being said, it’s important to remember that the successes of the Berlin patient and the London patient occurred under very special circumstances. The procedures were intended to treat cancer, and they came with a large price tag and an even larger risk. After the Berlin Patient, many of the attempts to replicate his treatment ended with the virus coming back, or with HIV+ patients dying from their cancer. Brown himself almost died immediately following the procedure because of the toll it took on his immune system.
In terms of the major developments using the CRISPR method, it’s important to remember that gene editing is still a very new technology. While eliminating HIV in mice was certainly a major feat, we’re still a while away from being able to safely test the CRISPR method on humans.
Experts also warn that further analysis is needed before calling the São Paulo patient’s experimental drug therapy a “cure.” While he maintained viral suppression, he was the only one among a group of five patients to not see the virus return. There have been past cases where patients (like the Mississippi Baby) have maintained viral suppression only to see the virus rebound after a few years. While the São Paulo patient’s status is very promising news, global scientists have stated they look forward to seeing multiple cases of long term remission using this treatment method.
These discoveries also do not change the current situation for most of the 38 million people currently living with HIV, the majority of whom are in sub-Saharan Africa. Given roughly a third of all people living with HIV still lack access to daily HIV medication, neither a rare, dangerous, and costly procedure, or an unproven intensive treatment regimen, is a realistic solution to the AIDS pandemic at this time.
We should applaud these groundbreaking discoveries, but we’re not at the finish line yet.
This is why the Global Fund, the organization that receives 100% of money generated by (RED) partners, is so important. While the medical community continues to work on finding a safe, cost-effective cure for HIV/AIDS, Global Fund programs in over 100 countries are focused on scaling up access to daily antiretroviral medication—the current, closest thing to a cure for people living with HIV. These programs also provide prevention services, care, treatment and education to the people most affected by HIV, which are crucial to limiting the spread of the virus.
Given the devastating impact of the current COVID-19 pandemic on the fight to end AIDS, supporting the Global Fund is more crucial now than ever before. Join (RED) and help ensure those living with HIV can continue to access essential programs and services.
Updated October 2020