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.

The post Behind the research: how close are we to a cure for HIV? appeared first on Your Health Matters.

“Those presentations were not common in people with normal immune systems, and I remember thinking it was odd that many of the patients were so young,” she says. It wasn’t long before the full picture emerged: it was the early days of the HIV/AIDS epidemic, and internal medicine wards were filling up with very sick patients whose HIV infection had progressed to AIDS.

Sensing a need for more specialized care, Dr. Rachlis advocated for an outpatient clinic dedicated to treating people living with HIV. The clinic opened at Sunnybrook in 1989. Originally comprised of just one nurse and 275 patients, the clinic quickly grew to 10 staff members and over 1,000 patients. A pioneer in her field, she was one of the few health care providers willing to take on the management of people living with HIV at the time.

Nearly three decades later the clinic is still operating, with an important change: in recognition of her dedication to HIV for 30 years, it’s being renamed The Anita Rachlis Clinic.

As Dr. Rachlis prepares to retire at the end of 2017 after 40 years at Sunnybrook, she reflects on her career and her work in HIV.

What was it like working an infectious diseases physician in the early days of the HIV/AIDS epidemic?

Caring for this patient population was, and still is, complex. Initially, some patients required daily infusions and more support from a variety of healthcare professionals, including dietitians and physiotherapists. Antiretroviral medications (ARVs) weren’t available until the late 1980s, making it even more challenging to treat patients. The turning point didn’t come until 1996, when new, much more effective drugs (specifically, the protease inhibitors) became available.

What’s the biggest change you’ve noticed in your 30 years of working with HIV patients?

Originally, the majority of the patients we saw were inpatients, and since there were no effective treatment options, many of them died. When the newer drugs became available in 1996, that changed almost overnight. People were surviving and all of the sudden, we were mostly seeing outpatients. Today, it’s not very common for us to see patients who’ve been admitted to the hospital.

What’s your proudest achievement?

Getting people living with HIV involved in teaching the next generation of medical students. With a group of medical students and residents I got a Canadian Institutes of Health Research (CIHR) grant to evaluate the role of people living with HIV as patient instructors, in order to reduce stigma and improve interest around HIV care among medical students. The results of the study led to HIV testing and pre- and post-test counselling being incorporated into the undergraduate medical preclerkship curriculum.

What’s the most important thing you learned while working in the HIV field?

I learned about the importance of advocacy, and how your voice can make a difference. It’s so important to involve patients, and to do things together. Things get done when there’s involvement of the community that’s being impacted.

For example, more treatments for HIV became available over time, but they were very expensive ($20,000 a year per patient). We lobbied the government for universal access to these drugs in Ontario. One of my patients made a videotape of himself reading a letter I’d written about the importance of universal access, just one day before he passed away from complications from AIDS.

Although that didn’t happen in Ontario, patients are able to access the therapies they need, either through the Ontario Drug Benefit program, the Trillium program or with the help from the pharmaceutical industry.

That level of activism, and of working together to get things done, was quite unique to the area of HIV. I’m proud to have been a part of it.

What’s surprised you the most?

The pace of change has been so dramatic. While HIV is still a disease of isolation, stigma and discrimination, patients are now able to live long, full lives – I’ve been seeing some patients for over 20 years. Mothers with HIV are now able to give birth to uninfected children, which they probably never realized would be possible. Of course, having an incredibly dedicated clinic team over these past few decades has made this work possible, and I’m appreciative of their commitment to HIV.

The post Meet the woman who pioneered HIV care at Sunnybrook appeared first on Your Health Matters.