First person ever ‘cured’ of HIV using medication alone, marking the most exciting breakthrough in the fight against the virus in years
In a major leap forward in the search for a HIV/AIDS cure, a person has been “cured” of HIV using a cocktail of medicines in what activists have dubbed a breakthrough as “exciting” as it was “unexpected”.
HIV, known as human immunodeficiency virus, hobbles people’s immune systems leaving them more vulnerable to once everyday diseases.
In a new study, presented Tuesday (July 7) at the International AIDS conference 2020, a patient on a relatively simple antiretroviral drug regimen was given a medicine commonly used to treat skin cancer.
Previous milestones of individuals’ HIV appearing to go into long-term remission resulted from bone-marrow transplants given to infected patients. Similarly, the transplants were intended to treat cancer in the patients, not HIV.
But bone-marrow transplants – on top of being costly – are unlikely to be realistic or reliable treatment options and are, at times, riddled with risk. Yet, this case involved no invasive medical procedures.
As a result, experts told PinkNews, while they are wearily calling it a “cure” for the virus, it is difficult how to define the word when instances of the virus’ demise are so few.
Moreover, they said, caution must be exercised in pivoting the case as a success, as scientists must assess whether the outcome can be replicated.
And while the HIV epidemic continues, advocates have warned that the emergence of the coronavirus pandemic – its continually sweeping infection rates and how it is vacuuming the attention of scientists and healthcare officials – will no doubt knock back success made in recent years.
HIV did not ‘rebound’ in patient even after being taken off of life-saving antiretroviral drugs.
Dr Andrea Savarino, of the Instituto Superiore di Sanitá in Rome, Italy, explained to HIV advocacy group aidsmap during a video call seen by PinkNews that the patient, one of five, was given an experimental drug commonly used as a skin cancer preventative called Nicotinamide as part of the study.
The medicine boosts the immune system, and some academics have demonstrated how Nicotinamide inhibits advanced stages of HIV infection in cell culture and works on “multiple mechanisms” to reel back HIV, Savarino said.
By the end of the study, Savarino said, a common indicator of the virus’ presence – viral DNA – was “undetectable” in the patient. Savarino admitted this was not an “optimal marker”, “but it may give an indication of the size of the viral reservoir.”
Researchers have long struggled to find a way to destroy HIV reservoirs – clusters of infected immune cells that are not producing new HIV – but this strategy, Savarino explained, may provide a possible blueprint.
Even after the patient was taken off of his antiretrovirals treatments, “the virus did not rebound, the viral DNA was maintained negative”, he said. “The antibody response decreased over time, if the antibody decreases, it is possible that the virus has stopped its repetition.”
The other four patients did rebound, the researcher said.
He stressed that the antibodies made to fight HIV have not disappeared altogether, but did decrease – “he’s still being monitored in order to understand whether the antibodies might disappear as in the case of Mr Timothy Brown,” Savarino added.
Brown, often referred to as the “Berlin patient”, beat HIV with a combination of stem cell transplants and radiotherapy following a diagnosis of leukaemia.
During the trial, only “mild side-effects” were observed from the cocktail of medicines: No real side-effects were observed from Nicotinamide, which was in-line with previous trials of the medicine’s impact on cancer.
However, the HIV expert stressed that those living with HIV should not take Nicotinamide in a non-medical setting, being that it is a potent and still experimental medicine.
“I really hope that [the study] boosts further research into a HIV cure because it is the first time such a condition is seen, to my knowledge, in a patient under chronic HIV infection, and without having been subjected to a life-threatening medical procedure such as bone marrow transplant,” he said.
“However, this is our very first experiment, and I wouldn’t foresee beyond that.”
HIV experts stress ‘caution’ over ‘cure’: ‘Further trials are necessary to find out whether it works for others’.
“This was an unexpected result – it’s proof of a concept that we weren’t really looking out for,” Matthew Hodson, executive director of aidsmap, told PinkNews.
“We have had effective treatment for HIV for 34 years but 690,000 people died of AIDS last year.
“We anticipate that due to COVID’s disruption of health services there will be an even greater number of AIDS-related deaths this year. People around the world are desperately in need of a cure and this case does give us renewed hope.
“Although the news is exciting, at this point we have to proceed with caution. We know that a very small number of people can achieve what appears to be remission with antiretroviral drugs alone and it remains possible that this is the case here.
“We need to know whether this finding will be replicated in other people, especially as it was not replicated in four other people on the trial.
“This particular treatment is relatively inexpensive and, unlike the bone marrow transplant that resulted in previous ‘cure’ cases, is not especially dangerous to the patient.
This gives me hope that it could be rolled out widely if we found it to work in other people.
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“Only one person in the small group given this treatment seems to be cured.
“Further trials are necessary to find out whether it works for others and which part of the treatment made the difference. This means that it will be some years yet before this treatment will be accessible.”
The global fight against AIDS was staggering even before the COVID-19 pandemic, activists admitted, as the United Nations said Sunday that global HIV targets will not be reached.
The organisation’s AIDS agency said in a report that COVID-19 may hurl progress against the virus back by a decade or even more.
Data from 2019 shows that more than 38 million people worldwide have acquired HIV – a million more than in 2018.
UN officials noted that while some 25.7 million people living with HIV were on antiretroviral treatment in 2019 – a feat unimaginable a decade prior – it still leaves 12.6 million not on the life-saving medications.