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The London Patient’s Functional HIV Cure Headlines Huge Week for HIV Research

Eleven years ago at the Conference on Retroviruses and Opportunistic Infections (CROI), the news of Timothy Ray Brown becoming the first person living with HIV to be functionally cured of the virus following a stem cell transplant shocked the world, allowing HIV advocates to hope that an HIV cure might be possible. This week, it was revealed at CROI that someone else living with HIV had achieved HIV remission for 18 months and was seemingly the second person to be functionally cured of HIV.

Like Timothy Ray Brown, this second person to achieve long term HIV remission—widely referred to as the London patient—eliminated the virus from his system after receiving a stem cell transplant to treat blood cancers (Brown was treated for Leukemia, while the London patient was treated for Hodgkin’s lymphoma). In both cases, the stem cell transplant was carried out with cells from a donor who possessed rare genetic mutations that remove the CCR5 receptor from the surface of CD4 T cells, which serve as the mechanism that most types of HIV use to infect cells.

News of the London patient’s functional HIV cure spread far and wide in the wake of its announcement at CROI, with even President Trump chiming in on the subject. “‘HIV Is Cured In 2nd Patient, Doctors Report.’ @NYTimes”, wrote Trump, adding, “Such great news for so many. Tremendous progress being made!”

Hopefully, the President’s support and informal endorsement of the London patient’s success in achieving long-term HIV remission using stem cell transplants indicates a new willingness to support stem cell research moving forward. In December of last year, HIV advocates were greatly concerned by reports that conservative opposition to the use of stem cells could result in the termination of a National Institutes of Health (NIH) contract for HIV vaccine research. NIH recently extended the contract for another 90 days, which will keep this vital research going temporarily, but has done little to ease worries that the Administration could rescind its support in the future.

The news of second person to be functionally cured of HIV is very exciting, but researchers like National Institute of Allergies and Infectious Diseases Head Anthony Fauci, MD were quick to point out that the invasive and complicated nature of the stem cell transplant procedure place significant limitations on its use. “If you want to then say, 'this is how we're going to be scaling up treatment,' it's not feasible,” Fauci said. “It's not broadly applicable and not scaleable under any circumstances.”

While the London patient garnered most of the headlines in the mainstream press, there were a number of other groundbreaking revelations concerning HIV treatment and prevention at this year’s CROI that may not represent an HIV cure but could impact the lives of millions of people living with and at risk of contracting HIV.

In one potentially game-changing study, researchers found that daily use of the drug Descovy (emtricitabine/tenofovir alafenamide) as Pre-exposure Prophylaxis (PrEP) was non-inferior to Truvada as PrEP in men who have sex with men. This finding is particularly important because Truvada, while remarkably effective at preventing HIV infection, comes with a number of damaging side effects, like decreased kidney function and reduced bone density. Per this study, Descovy had significantly better outcomes concerning bone and renal safety, while showing equal effectiveness at preventing HIV infection.

Another study unveiled at CROI this year showed that combinations of the antiretroviral drugs cabotegravir and rilpivirine, injected every four weeks, was non-inferior in maintaining viral suppression in adults living with HIV than a standard, daily, oral three-drug regimen. The vast majority of patients in the study said they preferred receiving the monthly injectable treatment over the daily pill regimen, which could represent a paradigm shift in the delivery of HIV treatment if it is able to be scaled up.

All of the findings released at this year’s CROI are only possible with significant, long-term investment in HIV research. AIDS United encourages both Congress and the Trump administration to provide sustained, multi-year increases of at least 10-15% annually for HIV research at NIH to maitain the progress we have made and expand upon emerging research opportunities.

Posted By: AIDS United, Policy Department - Friday, March 08, 2019

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