Surely after five years’ of HIV not reappearing in this man’s system everyone should celebrate that he’s been cured . . . and then work out how to apply a less complex but equally effective cure to the millions around the world who suffer from HIV!
Strange how people are reluctant to accept that this man IS cured.
Because its not a cure in the true sense of the word, the patients viral load is simply undetectable in the same way a patient who has been consistently taking their antiretroviral meds could very well be. It would be wrong to glorify this as a cure and detract away from the seriousness of infection.
The difference being that if someone we to come off their medication, their viral load would start to climb again, whereas in this man’s case, it remains effectively undetectable. One would also assume that after 5 years his T-Helper cell count would also have reverted to normal.
If this is true, they need to get working on a less invasive/ life-threatening version stat.
It could save so many lives.
There has been a great deal of interest in genetic modification of stem cells to produce T Cells within the body that are resistant to HIV. One problem with HIV is that it can use two different methods to attach itself to the T Cells & infect them. The Delta 32 double deletion gene therapy can make human T Cells immune to R5 type virus, but not the other type X4.
Most people have R5 virus in early infection – but HIV can change to also use the X4 route later on which potentially means that the gene therapy would not be permanent. There is still research going on with gene therapy.
It must be easy enough to verify?
This blood stem cell transplant he received sounds like a serious procedure.
I don’t know much about transplants but thought that people who receive transplants are often (always?) required to take medication for the rest of their lives so their body does not reject the transplant.
This is interesting news but it’s early days.
One of the questions that remain about the “Berlin Patient” is there is HIV DNA hiding in latent (inactive) T Cells? Some of these cells can remain inactive for up to 70 yrs, yet have the HIV DNA embedded within them, which the body cannot detect.
If just one or two of these cells is still present as soon as they become activated they will start to produce HIV again.
Also as I understand it different sensitivity HIV RNA tests have been used to determine if HIV is present – some of these tests have shown extremely low levels of HIV RNA, still present.
Because of the genetic modification of the T Cells viral replication is halted for R5 virus, but this still leaves potential pockets of X4 virus that can overcome the genetic modification of the T cells.
Perhaps 5 yrs is a little premature to be completely sure, but as with the analogy to cancer, this patient is very much in remission – lets hope it stays this way as it demonstrates proof of concept beyond doubt.
Am I right in assuming though that RNA fragments are merely the remains of the viruses attempt to recode the human DNA that failed? If the virus is not present, then surely the RNA strands are harmless and inert?
The simple answer is no. HIV is a retrovirus & comprises of two strands of RNA (rather than a single strand of DNA) together with other essential components to produce huge amounts of new virus. Outside the CD4 cell HIV is harmless as it requires the T cell machinery to create new copies of itself. The single RNA strands are “transcribed” to produce a strand of viral DNA that is then inserted into the human DNA strand within the T cell.
This “combined” DNA in the cell nucleus can lay dormant for many years – as soon as that particular cell becomes activated all the proteins to produce new virus are churned out by the infected T cell, which is destroyed in the process. This is why there is some reluctance to say that the “Berlin Patient” has been cured & all the embedded viral genetic material has been removed.
Basically HIV is a rogue strand of DNA which unfortunately destroys T cells when it reproduces & one that tricks the immune system by being almost invisible.
But whether or not the virus itself is true DNA or recombinant RNA shouldn’t important, should it? – The RNA transcription requires an external factor in order to bind itself into the human DNA strand and allow it to replicate, does it not?
Surely the presence of a few remnants of RNA floating about may be indicative, but is not proof positive that the patient is HIV+
The problem being that there could be some dormant CD4 cells containing recombinant HIV / Human DNA. This guy is effectively immune to R5 tropic virus because of the gene therapy, so in theory if these dormant cells became activated they could produce new virus which would be short lived as they would not be able to reproduce in this guys body.
I think it has been suggested that if there was any X4 tropic virus present in the dormant T cells this would be able to re-infect the genetically modified T cells – I think it is seen as a theoretical possibility as it is very rare for someone to only have R5 tropic virus, most have a mixture of R5/X4.
I guess the distinction needs to be made between a “functional cure” which this is and a “sterilising cure” where HIV genetic material has been totally eradicated from the body. I think this is where there are different views as to whether this guy has been truly cured.
Surely a functional cure has to be better than the crappy medication and all their associated side-effects?
It may not be a perfect solution, but it has to be a step in the right direction.
A functional cure would be very welcome indeed – there are various research projects looking into this, but as yet we have not moved much beyond proof of concept. It is interesting that many people who do not have HIV often refer to the side effects related to taking meds. As I have said many times modern drugs have far less side effects & where there are known potential adverse events these can be closely monitored & changes made as appropriate.
There is also the argument that as HIV positive individuals we should be asking for changes to our treatments where side effects are present – sadly many patients do not feel empowered enough to make their clinicians aware of the problems, often thinking “better the devil as in drug you know”. To me this is a sad state of affairs & results in problems further down the line.
I will soon be taking just one ARV instead of 3 – this has to be a good thing & I do not envisage any real lasting side effects, if there are I will simply switch back.
Well I am not HIV myself, but I have friends who are, and I have also studied biology so it is something of a pet interest of mine. I realise that the combination therapy meds are far more effective and less intrusive than earlier treatments, but they still have their problems ranging from nausea through poor sleep to lipodystrophy and weight loss. Any way around that has to be good.
Of course anything that reduces the dependance on daily meds is welcome – but I would challenge your friends & ask them have if they have fully discussed the range of symptoms you describe with their HIV Consultant?
Nausea & other gastro-intestinal side effects can be managed with a change of regimen if there is no resistance present – insomnia can also be managed with a change of meds. – Ok many are not aware of the alternatives, but in my view it is possible to get a treatment regimen that is devoid of side effects, sadly this often means having a very robust & informed conversation with the HIV Consultant – something that many shy away from!
As with everything in life you only get what you expect – if you expect side effects & do nothing to change those side effects, then they will continue! My view is never accept the inevitable – take control!
There are plenty of resources available today – no one should be suffering with side effects of modern HIV treatments.
Actually upon reflection it is not totally accurate to say that HIV is harmless outside the human T cell. Once antibodies have been formed to HIV the body launches a strong immune response which in the long term puts the immune system into overdrive & causes a chronic state inflammation within the body. Untreated HIV can have a huge effect on bone metabolism, cardiovascular disease, kidney tubule damage & changes in neuro-cognitive function,
This is why it is essential to get people tested regularly as there is more & more evidence to suggest that untreated HIV causes other problems than those associated with the traditional opportunistic infections that characterise a weakened immune system.
I was always led to believe that HIV was a pretty fragile organism outside the T cell, and unless it got itself embedded pretty quickly, it could be eradicated from within the bloodstream simply by antibody activity.
It is true to say that HIV is a fragile virus, but there are several factors at play; the most important being that each infected T cell can produce millions of virus copies before it is destroyed. By the time antibodies have been produced by the body to control the infection millions if not billions of T cells will have been infected many of which will then lay dormant for varying times, invisible to the immune system. This effectively creates stores of HIV genetic material that can be activated at any time. At any one time there are only 2% of T cells in the blood, the rest of them are located in the lymphoid tissue laying dormant.
The level of viral replication is very high as is the mutation rate, this means that the immune response is constantly behind the curve because of the small genetic mutations which allow HIV to evade the immune response. Eventually HIV wins the battle if it is left untreated & overwhelms the immune system.
The first time I heard that some people were naturally immune to HIV I thought GREAT! now all we have to do is figure out how their body does it and “teach” others bodies to do the same! I know it’s more complicated than that but this line of therapy should be vigorously pursued
I read once that HIV, especially in the gay community, will be hard to eradicate because few children are being born to POZ parents, therefore hampering nature’s way of evolving humans past HIV over time, seeing as str8 people largely bear children. Each generation of gay kids grows up to fall as pawns under the onslaught. Those immune tend to have immune children, and so it follows.
Of course, it means a great deal of death as those not immune fall by the wayside, but over time the species would evolve past it. ( I know the African str8 situtation IS this process at work – and over generations a weeding-out process will happen.)
Perhaps gene therapy will prove to be a shortcut to evolution?
Why do you see a ‘weeding out’ process?
Evolution is not guided by some primary directive – it simply exists and mutates – into what, nobody has any idea. The virus is one of natures most primitive lifeforms (if you can even call it life) – It just so happens human beings got in this one’s way. Man’s medical intervention will probably find the cure some day, but I really wouldn’t hold your breath.
Very interesting. Maybe this could be the beginnings of a major breakthrogh
It is wonderful to hear such news, but one has to take all this sort of thing with massive amounts of salt.
News agencies love to grab onto ‘exclusives’ like this in the vain hope they might the first to find something big, but as is often the case, particularly with technical, scientific and medical stories, they are insufficiently qualified to understand the information, and so read between the lines and draw their own conclusions.
Whatever the case, it is another line of approach to the HIV pandemic, and with the increased use of genetic therapy and stem cell research, it may in the future offer the permanent cure that so many people need.
Very encouraging, but different people react to different drugs regimens in different ways so I presume there would be many rigorous tests before this drug could be considered for general use as a one-size-fits-cure-all,