During a HIV conference, a London-based researcher presented the case of a second patient who has lived 18 months after stopping HIV treatment without sign of the virus following a stem-cell transplant, a possible second case of HIV being cured. (Mar 5)
Since news broke this week that a second HIV-positive patient was cured of the virus that causes AIDS, four people asked Dr. Ray Martins if they could have the stem-cell surgery.
The Washington, D.C., doctor says he wouldn’t recommend it.
Doctors are haling news of a potential breakthrough on a condition that has killed hundreds of thousands in the United States alone. But the operation is so onerous – and HIV now so manageable – that it could be a classic case of the cure being worse than the disease.
HIV was once a death sentence – it has killed some 35 million people worldwide. But now, by taking one or two pills a day, most patients can suppress viral loads to the point that they can neither be detected nor passed on to others.
The still-experimental surgery involves chemotherapy and a bone marrow transplant using stem cells. It’s painful, risky, and threatens harsh side effects that can last for years.
“It’s so dangerous,” Martins says, “I wouldn’t do that to someone who is healthy with HIV.”
Steven Deeks, a University of California, San Francisco professor involved in the cure research, says the procedure should be used only on cancer patients with HIV.
“This approach is just too, too dangerous for the treatment of HIV by itself,” Deeks says.
The London man who was reported to be cured of HIV this week and the Berlin patient, who was cured in 2007 both had cancer.
A third man from Dusseldorf, Germany, has had a similar transplant and been off his HIV medication for more than three months, Deeks says. But doctors want more time before declaring him cured.
Deeks says more research is needed before the treatment can be made available to the broader population infected with HIV.
“The big question is how do we use the lessons learned from these cases to come up with something that is safer and more scalable,” he says. “That’s an area of intense research.”
Some are skeptical that an HIV cure would make a meaningful difference in the lives of people who are living with the virus.
Keosha Bond, an assistant professor at New York Medical College who has researched HIV, says a therapy that relies on bone-marrow transplant won’t be practical for many.
“This is an awesome discovery,” Bond says. But “I’m not sure how this will affect everyone across the board, including populations that are at risk.”
Existing antiretroviral drugs, if taken consistently, can reduce viral loads to undetectable levels. And people at greater risk of contracting HIV through sex or injectable drug use might benefit from PrEP, a daily pill that combines the HIV medications tenofovir and emtricitabine to prevent new infections.
When patients take drugs to reduce their viral loads and reduce the risk of transmitting HIV to their partners, Bond says, it become a manageable condition.
“That right there is the biggest breakthrough we’ve had,” she says. “It’s always been looked at as a death sentence, something your tried to stay away from. Now we know that it’s treatable. You can live a healthy life and be HIV positive.”
Bond says educating at-risk groups, combating stigma and providing access to health care will do more to prevent new infections than a cure.
“We need to celebrate every achievement and every discovery,” she says. “But I think we need to think about the people who don’t have access.”
In 2015, Austin, Indiana, had the worst HIV outbreak ever caused by intravenous drug use in rural America.
“Canary in the Coal Mine,” Dr. Will Cooke’s book on the outbreak, is due out in September. Cooke still treats about 150 of these patients.
For these isolated, low-income patients’ worries, he says, “HIV is the least of their worries.”
None of Cooke’s patients has asked about the new cure. He says he wouldn’t recommend such a “radical” treatment.
“In the environment of the opioid crisis, the things that put them at risk of HIV in the first place haven’t gone away,” he says.
HIV-positive people have access to special services for food, transportation and housing. But “in a rural setting,” he says, “there is not a lot of housing available.”
He’s had patients who were evicted by landlords worried about the spread of HIV.
Michael Shilby has been HIV-positive since 1989. He contracted the virus at a time when discrimination was rampant and treatments were unwieldy and largely ineffective.
He says he was fired from a job at a hospital where he worked for eight years because he was gay and HIV-positive.
No matter what the doctors say, he says, he was excited by news of a possible cure.
“Are you kidding me? Sign me up,” he says. “You have no idea what we all have been through and the hoops we had to jump through and are still jumping through, with room to spare.”
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