Stem Cell Transplant; A Promising Cure For HIV?

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I realised that I have fewer times to spend on this platform each day so, for the sake of consistency, I would try to make a shorter article every day so that I can be active and contribute much more to Steemit community in terms of health and preventative medicine. Now, this article would focus on the current HIV treatment and some information regarding the latest cure which has been instituted on a patient in the UK currently known as the "London Patient". It's a bit unclear how he was cured by the same treatment given to the first ever HIV-cured patient known as the "Berlin Patient", but it does give us some insight into the future management of people with HIV.

In 2007, a patient from Germany named Timothy Ray Brown has been cured of HIV after a stem cell transplant for his leukaemia. He was first diagnosed with HIV in 1995 which required him to take a daily low dose of Zidovudine before he changed his medication to a protease inhibitor making him relatively normal and experienced fewer side effect; unlike zidovudine, it doesn't really implicate life-threatening side-effects. When protease inhibitor was commercialised in late 1995, the number of people dying from AIDS has been decreasing from 50,000 to 18,000 per year. Unfortunately, the number increase in the subsequent year by 20% which can be due to a few reasons like resistant species of HIV or an increased number of people diagnosed with HIV/AIDS.

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Nevertheless, after 10 years of taking the protease inhibitor, one day, Timothy felt weak and easily tired which prompted him to see his HIV doctor fearing his disease has progressed or his medication started unworking for whatever reasons; neither is true. He was found to have severe anaemia (reduced red blood cell) in which he was prescribed with blood transfusion for a few days; his problem persists. He was later referred to an oncologist which order a bone marrow biopsy and later, he was diagnosed with acute myeloid leukaemia (AML). He was scheduled to have 4 rounds of chemotherapy and experienced a few infections along the way, one of which put him into an induced coma.

His doctor then took a sample of his blood to check for matches as an alternative if he needed stem cell transplant; fortunately for him, he got 267 matches. That pool of potential stem cell made his doctor think, what if he tried to find a stem cell with a CCR5 Delta 32 mutation which in theory, could help him in term of his HIV problem. We all know that HIV has been infecting the CD4 cell and CCR5 is the protein which acts as a doorway to those viruses; if Timothy were transplanted with stem cell containing that kind of mutation, he would be immune, well in theory. After searching among the 267 patients, they found a donor which consented to the transplant.

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However, as Timothy was in remission, he doesn't consent to such a risky procedure. I mean, you wouldn't if the chances of you surviving were 50%. Furthermore, the efficacy of antiretroviral therapy has been proven by a few studies and Timothy could live quite a normal life without any risk or very low risk to transmit it to others when his viral count was "undetectable". However, in 2006, his leukaemia rebounded and it was obvious to him and his doctor that he needed a bone marrow transplant. After explaining the step of the procedure and the potential outcome of him post-surgical intervention with a mutated stem cell, he agreed to stop taking his antiretroviral medication so that we would know for sure that if his viral count was undetectable, it was not due to his antiretroviral medication.

He did the transplant twice (the second one in 2008) after the leukaemia came back while he was in Idaho but HIV was never detected in his blood. During his rehabilitation, he was asked whether or not they can discuss his case with medical students for academic purpose but he wasn't ready to be publicised yet so he used the name "Berlin patient" instead of his own name; eventually he made an official announcement regarding his cured status in 2010 so the codename was replaced with his real name. It was a moment of truth and in 2012, he created a foundation dedicating to find a cure so that more HIV patient can be treated indefinitely.

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Recently, there has been great news regarding the second patient which was cured of HIV by stem cell transplant and yesterday, I was informed that there is a third patient from Germany known as the "Dusseldorf patient". The latter has stopped taking his antiretroviral medication for 3 months and they aren't any evidence of HIV in his lymph node or guts. Although we should continue to monitor their progress for a significant duration, this can be a promising ground for HIV cure and save millions of lives from the inevitable consequences of AIDS. Stem cell transplant is a risky treatment and there are not so many people who have such genetic defects which confer immunity against HIV I but some scientists suggested that HIV cure can also potentially be achieved by a new technology called CRISPR/Cas9 gene-editing. Maybe we will talk about it in a later article.

So what about highly active antiretroviral therapy (HAART)? Well, studies have shown that treatment with HAART at an early phase of the disease can reduce the viral load to insignificant level (in which they can't be transmitted to others) and extend their life expectancy to the same years as the general population; even longer as people with HIV are generally screened with other diseases at an early phase which increased their quality of life and outcomes. Stem cell transplant is not a standard procedure to treat HIV but it is indicated in patients who are diagnosed with a specific kind of haematological cancer. It won't be long before scientist would be able to replicate the curative effect of stem cell transplant by instituting a much safer treatment or even an upgrade of HAART. I hope I will live long enough to witness such a scientific breakthrough.s

Sources

• Could a Third Person Be Cured of HIV?
• I Am the Berlin Patient: A Personal Reflection
• Protease inhibitor (pharmacology)
• The London Patient and a Plan to End the H.I.V. Epidemic in the United States
• Third person 'cleared of HIV,' scientists say just days after London patient declared second in world to be 'functionally cured'
• HAART in HIV/AIDS Treatments: Future Trends

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