Published: Sun, March 10, 2019
Health Care | By Cedric Leonard

Monthly Injections Could Replace the Daily Pill Regime of HIV Patients

Monthly Injections Could Replace the Daily Pill Regime of HIV Patients

On Monday, doctors revealed a second patient, called the "London patient", had been off his antiviral medications for 18 months following his bone marrow transplant cancer treatment and had no signs of HIV.

The Dusseldorf patient also received a bone marrow transplant from a donor with the CCR5 mutation.

Given recent disappointments after hematopoietic stem cell transplantations in people living with HIV, the team reporting on remission of the London patient does not describe their patient as cured.

The third patient, from Dusseldorf, had apparently been HIV-free for three months, with no evidence of HIV in the gut and lymph nodes. The first was the case of the Berlin patient, Timothy Ray Brown, who received similar treatment for cancer in 2007. KIRO Radio's Mike Lewis spoke with Fred Hutchison HIV researcher Dr. Josh Schiffer, who discussed his reaction to hearing the news and what this breakthrough means in the fight against HIV.

Condoms remain the most widely available and low-cost form of HIV prevention. Unfortunately, the treatment the Berlin and London patients had have failed in other patients, so it is not considered a cure.

Experts universally hailed the case, even as they cautioned that the procedure that resulted in the likely cure - a bone marrow transplant to treat blood cancer - is too risky and costly to be applied as a general treatment for HIV, which can today easily be managed, though not cured, with pills.

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A big hurdle in such research is the difficulty of finding donors with the CCR5 delta 32 genetic mutation, given that the percentage of people with the mutation is very low among the total population, he said. The inability to find HIV in their blood, coupled with the missing CCR5 receptor, constitutes the HIV viral remission of the London patient announced earlier this week. As part of his treatment for leukemia, which is a cancer of the immune system, his immune cells were destroyed and replaced with donor cells with the mutation. "Instead of being reminded that you have HIV 365 days a year, it's reduced to just 12".

The CCR5 gene, and the eponymous cell it codes for, nearly certainly play a crucial role in the collateral HIV cure. Scientists have been monitoring his blood closely, and only one test in that time showed any traces of the virus; they suggest that result could be due to contamination of the test.

He added: "Although the finding is exciting, it is not offering up a new treatment for the millions of people around the world living with HIV". In 2016, a cancer that affected his immune system developed.

The vast majority of HIV virus strains use the CCR5 molecule, or receptor, as the port of entry into human cells. Then the patient receives a transplant of new stem cells from either themselves or a donor. HIV has become a chronic condition in which progression to AIDS is increasingly rare.

Most importantly, the HIV community learned that Brown's case was not unique.

The next big question is how the knowledge gained from CCR5 stem cell transplants might actually help create a true cure for HIV. Instead of having to do not forget to take pills, patients instead could get injections from a doctor or nurse each month.

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