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In search of an AIDS cure: HIV/AIDS and bone-marrow transplant
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AIDS Quilt, AIDS Walk, Central Park, by Alina Oswald
Finding an AIDS cure has always been an ultimate goal for medical experts, ever since the early days of the epidemic. While the first four years of the AIDS epidemic were years of silent suffering and horrible deaths governed by a killer disease and an indifferent administration, in 1985 health officials announced the name of the virus causing what we know today as AIDS. The health officials also announced that their confidence that a cure was soon to follow. Yet, the virus continued to infect and then decimate its victims, so much that during the early nineties the number of AIDS-related deaths increased exponentially. There was no cure in sight. The only available treatment was AZT, which became available in 1987 and which had serious negative side effects.
The advent of HAART regimens during the mid-nineties brought much needed hope to the fight against AIDS in patients and medical professionals alike. Because of their ability to bring patients back to life from the brink of death, the new medications (also referred to as "the cocktail") were associated with a "Lazarus effect." Soon, though, patients started realizing that, in order to stay alive and a step ahead of the disease, they needed to take the powerful medications every single day, for the rest of their lives.
Nowadays there are 20 HAART medications available. They don't come without serious side effects, some of which can kill the patients, some of which redefine the so-called "face of AIDS," thus contributing to the ongoing related stigma and prejudice. And, no matter how revolutionary they may be, HAART regimens are no AIDS cure.
The struggle to find a cure hasn’t been abandoned, though. This year has brought new hope in the search for an AIDS cure through a new kind of “patient zero” – one who may be considered the first patient to have been cured from AIDS. The AIDS patient in question is a 42-year-old American living in Germany, and who also had leukemia. In order to treat his leukemia, doctors at the medical center in Berlin, Germany, decided to give him a bone marrow transplant. They chose a donor who was naturally resistant to HIV.
The virus can use two ways to attach itself to the T cell. Mostly it uses a molecule called CCR5 on the surface of the cell. (There are medications, nowadays, that work by blocking the CCR5 molecule receptor). In individuals with CCR5 mutation, the molecule does not appear on the surface of the T cell, thus disabling HIV from attaching itself to the T cell using the CCR5 molecule. This genetic mutation is present only in one percent of Europeans and is almost non-existent in Asians and Africans.
Six hundred days and counting after the procedure, the patient didn't show any signs of leukemia or AIDS. Almost two years after the procedure and of continuous monitoring, doctors found no HIV in the patient's body.
Does it mean that now we have an available AIDS cure? And if so, is it available to the tens of millions of people living with the virus? Opinions may vary widely, from the skeptics who believe in HIV’s capability to go "in hiding" in the human body and reemerge at a later time, to those who see this procedure as a first step towards an AIDS cure, yet still have plenty of questions.
In preparation for the bone marrow transplant, German doctors took their patient off the HIV medications, not to interfere with the procedure. (They were to put him back on the HAART regimens afterwards.) In preparation for the transplant, doctors also had to put their patient on powerful medications to destroy his own bone marrow—that generates immune system cells—in order to get him ready for receiving the new bone marrow.
The procedure is extremely expensive, at least for now. The procedure is also extremely difficult. A transplant may be possible only for cancer patients in stage two of the disease. In addition, finding a donor is quite complicated. Finding a donor who is naturally resistant to becoming infected with HIV is even more difficult. In addition, the transplant itself has a 30 percent mortality rate.
There also seems to be a safer way. Many are hopeful that gene therapy may hold the answer to an AIDS cure. Gene therapy requires doctors to reengineer a patient's own cells. But gene therapy can be daunting and it has its own history of failed trails, one prominent example being that of an 18-year-old patient who died while in a gene therapy trial. Also, studies have shown that the CCR5 blocking can have its own side-effects. For example, individuals who carry this mutation become more likely to die from West Nile virus.
Transplants on AIDS patients are no novelty. In 1989, a 41-year-old AIDS patient with lymphoma had to go through radiation therapy to kill his bone marrow in order to receive new cells from a donor. It's no sure if the donor had the CCR5 mutation or not. After the procedure, HIV disappeared from the patient’s body, yet he died of his cancer 47 days later. Autopsy also confirmed the absence of HIV in the body.
Regardless of the new and hopeful developments in the fight against the epidemic, experts agree that we’re far from an AIDS cure, one that is affordable to everybody. Meanwhile, medical experts urge patients to stay on their treatments.
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