This week, researchers in London announced that for only the second time ever, a patient appears to be free of HIV after receiving a bone marrow transplant to treat blood cancer. To learn more about what this means for HIV treatment and research, we spoke to Dr. Adrienne Chan, an infectious diseases physician who works in the Anita Rachlis HIV Clinic at Sunnybrook.
How big is this news about a second patient having no detectable HIV after a bone marrow transplant?
It’s very big news. We’ve waited so long to see these results replicated after the first patient [American Timothy Ray Brown in 2007]. It really opens up the imagination for what can be done around cure research in HIV.
As exciting as it is, however, we also have to be mindful about what’s realistic for our patients. But it does shine a light on the amazing work going on in HIV research right now.
What does this mean for HIV patients?
There have been other cases of HIV patients who’ve required bone marrow transplants, often for blood cancers, but only one patient had managed to stay off of antiretroviral (ARV) medication until now.
While it’s unlikely that this particular treatment will ever be widely offered due to the risks involved, it’s still good to see things like this happen. The success of the transplant in a second patient has also now identified a potential target for researchers interested in cure, to look at things like gene therapies or specialized antibodies.
It’s important to remember that worldwide, there are 37 million people living with the virus, and 40% of them are still not accessing ARV treatment, which we know works and can keep the virus suppressed. HIV is a chronic disease and it is critical that we don’t take the foot off the gas pedal for resources supporting prevention, testing and treatment programs.
Why can’t a bone marrow transplant be offered as a standard treatment to all patients with HIV?
A bone marrow transplant is a very risky, potentially life-threatening treatment. These two patients needed it because they had severe blood cancers, and they had to go through several rounds of chemotherapy and/or radiation first. It’s a therapy that won’t be readily available or indicated for the vast majority of HIV patients.
What’s next in HIV research?
There is still a lot of work to do in reaching that 40% of people with HIV who aren’t accessing treatment, whether it’s due to cost, location, stigma or other factors.
For example, a study published last week found that community-based testing and getting people on treatment reduces HIV infections by 30%. There are simple solutions that can be used to continue fighting this epidemic.
How far has HIV research come during your career?
With proper treatment, HIV is no longer the “death sentence” it once was. Today, it’s treated as a chronic disease, and we have readily available treatment that can lead to life expectancy that’s just as good as someone who doesn’t have HIV.
I started working as a student on HIV vaccine research back in the early 1990s, and to hear that there’s a second functional cure case is pretty amazing. Some of the patients we see at the Anita Rachlis HIV Clinic have been on treatment since the 1980s and are doing remarkably well, so it’s quite inspiring to see how much things have changed.
