The first person to be cured of HIV, Timothy Ray Brown — known as the “Berlin Patient” — has died after a battle with cancer, the International Aids Society (IAS) announced Wednesday.
Brown made medical history and became a symbol of hope for the tens of millions of people living with the virus that causes AIDS when he was cured more than a decade ago.
He had been living with a recurrence of leukaemia for several months and received hospice care at his home in Palm Springs, California.
“On behalf of all its members… the IAS sends its condolences to Timothy’s partner, Tim, and his family and friends,” said IAS President Adeeba Kamarulzaman.
“We owe Timothy and his doctor, Gero Hutter, a great deal of gratitude for opening the door for scientists to explore the concept that a cure for HIV is possible.”
Brown was diagnosed with HIV while was studying in Berlin in 1995. A decade later, he was diagnosed with leukaemia, a cancer that affects the blood and bone marrow.
To treat his leukaemia, his doctor at the Free University of Berlin used a stem cell transplant from a donor who had a rare genetic mutation that gave him natural resistance to HIV, hoping it may wipe out both diseases.
It took two painful and dangerous procedures, but it was a success: in 2008 Brown was declared free of the two ailments, and was initially dubbed “the Berlin Patient” at a medical conference to preserve his anonymity.
Two years later, he decided to break his silence and went on to become a public figure, giving speeches and interviews and starting his own foundation.
“I am living proof that there could be a cure for AIDS,” he told AFP in 2012. “It’s very wonderful, being cured of HIV.”
– ‘Champion’ – Ten years after Brown was cured, a second HIV sufferer — dubbed “the London Patient” — was revealed to be in remission 19 months after undergoing a similar procedure.
The patient, Adam Castillejo, is currently HIV-free. In August a California woman was reported to have no traces of HIV despite not using an anti-retroviral treatment.
It is thought she may be the first person to be cured of HIV without undergoing the risky bone marrow treatment.
Sharon Lewin, the president-elect of the IAS and director of the Doherty Institute in Melbourne, Australia, praised Brown as a “champion and advocate” of a cure for HIV.
“It is the hope of the scientific community that one day we can honour his legacy with a safe, cost-effective and widely accessible strategy to achieve HIV remission and curs using gene edition or techniques that boost immune control,” she said.
The number of deaths from AIDS-related illnesses in sub-Saharan Africa could double if the provision of healthcare to HIV sufferers is disrupted during the coronavirus crisis, the United Nations said Monday.
A six-month disruption of antiretroviral therapy due to the COVID-19 pandemic could lead to more than 500,000 extra deaths in the region in 2020-2021, the World Health Organization (WHO) and the UNAIDS said in a joint statement.
In 2018 — the latest figures given — an estimated 470,000 people died of AIDS-related deaths in sub-Saharan Africa.
The two UN bodies warned of the impact if HIV services are closed, supply chains interrupted, or healthcare services overwhelmed due to the COVID-19 pandemic.
Modelling conducted for the agencies said a six-month disruption in HIV healthcare services could turn the clock back to 2008, when more than 950,000 AIDS-related deaths were recorded in the region.
“The terrible prospect of half a million more people in Africa dying of AIDS-related illnesses is like stepping back into history,” said WHO director-general Tedros Adhanom Ghebreyesus.
The knock-on effects would see people continue to die in excess numbers over the following five years, the statement said.
In sub-Saharan Africa in 2018, an estimated 25.7 million people were living with HIV, of whom 16.4 million were taking antiretroviral therapy.
Tedros said some countries were already implementing measures such as ensuring people can collect bulk packs of treatment and self-testing kits.
“We must also ensure that global supplies of tests and treatments continue to flow to the countries that need them,” he added.
– ‘Needless deaths’ –
Five teams of modellers used different approaches to work out the effects of possible disruptions to testing, prevention and treatment services caused by COVID-19.
With a six-month disruption, estimates of excess AIDS-related deaths in one year ranged from 471,000 to 673,000.
Disrupted services could also reverse gains made in preventing mother-to-child transmission of HIV, the agencies said.
HIV infections among children in sub-Saharan Africa have declined by 43 percent from 250,000 in 2010 to 140,000 in 2018.
Curtailment of HIV services for mothers and their children could see new child HIV infections rise by as much as 37 percent in Mozambique, 78 percent in Malawi and Zimbabwe, and 104 percent in Uganda, the modelling found.
“There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against COVID-19,” said UNAIDS executive director Winnie Byanyima.
“We cannot sit by and allow hundreds of thousands of people, many of them young, to die needless deaths.
“I urge governments to ensure that every man, women and child living with HIV get regular supplies of antiretroviral therapy — something that’s literally a life-saver.”
Since the first cases of HIV were reported more than 35 years ago, 78 million people have become infected with HIV and 35 million have died from AIDS-related illnesses, said UNAIDS.
Here is a list of dangerously contagious diseases that have been tagged ‘pandemic’.
The SARS-like virus discovered in the central Chinese city of Wuhan was first confirmed on December 31, 2019.
Coronaviruses are a large family of pathogens ranging from the common cold to more serious illnesses like SARS and Middle East Respiratory Syndrome (MERS), which emerged in 2012 and also caused scores of deaths.
The declaration was only due to the fact that its outbreak worldwide sparked fears and according to the WHO chief Tedros Adhanom Ghebreyesus, “the spread and severity of the deadly new coronavirus, which has infected more than 110,000 people and killed more than 4,000, is “alarming”.
He predicted that the number of cases and deaths would grow in the coming days and weeks.
The case fatality rate is estimated at between one and five percent but varies significantly by age and other health conditions.
The infection is spread from one person to others through respiratory droplets produced from the airways, often during coughing.
There is no available vaccine yet.
Already, COVID-19 has been confirmed in all the continents of the world.
The Human Immunodeficiency Virus (HIV) is a global pandemic which recorded 65 million infections and 25 million deaths globally.
In 2005 alone, an estimated 2.8 million persons died from AIDS, 4.1 million were newly infected with HIV, and 38.6 million were living with HIV
The virus targets the immune system and weakens people’s defence systems against infections and some types of cancer.
The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop if not treated.
HIV is transmitted through the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen, and vaginal secretions.
According to the WHO, HIV continues to be a major global public health issue with increasing access to effective prevention, diagnosis, treatment, and care, but the infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
Over two-thirds of all people living with HIV live in the WHO African Region (25.7 million).
In 2018, Sub-Saharan Africa, the region most affected, had an estimated 61 percent of new HIV infections.
There is no cure for HIV infection, but effective antiretroviral drugs (ARVs) can control the virus and help prevent onward transmission to other people.
Between 2000 and 2018, new HIV infections fell by 37 percent and HIV-related deaths fell by 45 percent, with 13.6 million lives saved due to antiretroviral therapy (ART).
Tuberculosis (TB) is a global disease, found in every country in the world, accounting for a total of 1.5 million deaths as of 2018.
It is caused by bacteria that most often affect the lungs, and is spread from person to person through the air when an infected person coughs, sneezes or spits.
People mostly adults in their most productive years, infected with the bacteria have a 5–15 percent lifetime risk of falling ill with TB.
According to facts by the WHO, TB is one of the top 10 causes of death and the leading cause of a single infectious agent (above HIV/AIDS).
In 2018, an estimated 10 million people fell ill with tuberculosis worldwide; 5.7 million men, 3.2 million women, and 1.1 million children, with cases recorded in all countries and age groups.
TB is curable and preventable, but globally, TB incidence is falling at about two percent per year.
Tuberculosis occurs in every part of the world; in 2018, the largest number of new TB cases occurred in the South-East Asian region, with 44% of new cases, followed by the African region, with 24% of new cases and the Western Pacific with 18%.
Eight countries account for two-thirds of the total, with India leading the count, followed by, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa.
Part of the health targets of the Sustainable Development Goals is to end TB epidemic by 2030.
4. The Black Death:
Also known as Great Bubonic Plague was regarded as one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people during the fourteenth century.
The plague is caused by the bacteria Yersinia pestis, a zoonotic bacterium usually found in small mammals and their fleas.
People infected with the plague often develop symptoms after an incubation period of one to seven days.
Details from the WHO said the Plague transmitted between animals and humans by the bite of infected fleas, direct contact with infected tissues, and inhalation of infected respiratory droplets.
The Black Death was the first major European outbreak of the plague and the second plague pandemic.
Although, the origination of the plague is uncertain, there are believes that it emanated from Central or East Asia.
Records show that the Black Death killed an estimated 30 to 60 percent of Europe’s population, and may have reduced the world population which cost Europe almost 200 years to recover its population.
From 2010 to 2015 there were 3248 cases reported worldwide, including 584 deaths.
Plague epidemics have occurred in Africa, Asia, and South America; but since the 1990s, most human cases have occurred in Africa.
Currently, the three most endemic countries are the Democratic Republic of the Congo, Madagascar, and Peru.
5. Spanish flu:
The 1918 influenza was the most severe pandemic in recent history, caused by the H1N1 influenza virus.
According to the Centers for Disease Control and Prevention (CDC), there is no universal consensus regarding where the virus originated, but it spread worldwide from 1918-1919.
It infected 500 million, out of the 1.8 and 1.9 billion people around the world including people on isolated Pacific islands and in the Arctic.
The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States, making it one of the deadliest epidemics in human history.
Mortality was high in people younger than five years old, 20-40 years old, and 65 years and older, and the properties that made it so devastating are not well understood.
With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections, control efforts worldwide were limited isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.
6. Swine Flu:
The 2009 pandemic is similar to the Spanish flu involving H1N1 influenza virus which lasted from early 2009 to late 2010.
In 2010, WHO Director-General, Dr Margaret Chan announced that the H1N1 influenza virus has moved into the post-pandemic period. However, localized outbreaks of various magnitudes are likely to continue.
Linked with pigs, it is a respiratory influenza virus that commonly circulates in swine, and in April 2009, the virus appeared to be a new strain of H1N1 which resulted when the bird, swine and human flu viruses combined with a Eurasian pig flu virus, leading to the term “swine flu”.
The infection was first recognized in the state of Veracruz, Mexico, with evidence that the virus had been present for months before it was officially called an “epidemic”, and it continued to spread globally.
It is estimated that 700 million–1.4 billion people contracted the illness, with about 150,000–575,000 fatalities, recording a much lower case fatality rate.
In late April the World Health Organization (WHO) declared it’s first-ever “public health emergency of international concern,” and in June, the WHO and the U.S. CDC stopped counting cases and declared the outbreak a pandemic.
The H1N1 virus does not infect adults older than 60 years, an unusual and characteristic feature of the H1N1 pandemic.
It is typically contracted by a person to person transmission through respiratory droplets and symptoms usually last 4–6 days.
A second patient has been cured of HIV after undergoing stem cell transplant treatment, doctors said Tuesday, after finding no trace of infection 30 months after he stopped traditional treatment.
The so-called “London Patient”, a cancer sufferer originally from Venezuela, made headlines last year when researchers at the University of Cambridge reported they had found no trace of the AIDS-causing virus in his blood for 18 months.
Ravindra Gupta, lead author of the study published in The Lancet HIV, said the new test results were “even more remarkable” and likely demonstrated the patient was cured.
“We’ve tested a sizeable set of sites that HIV likes to hide in and they are all pretty much negative for an active virus,” Gupta told AFP.
The patient, who revealed his identity this week as Adam Castillejo, 40, was diagnosed with HIV in 2003 and had been on medication to keep the disease in check since 2012.
Later that year, he was diagnosed with advanced Hodgkin’s Lymphoma, a deadly cancer.
In 2016 he underwent a bone marrow transplant to treat blood cancer, receiving stem cells from donors with a genetic mutation present in less than one percent of Europeans that prevents HIV from taking hold.
He becomes only the second person to be cured of HIV after American Timothy Brown, known as the “Berlin Patient”, recovered from HIV in 2011 following similar treatment.
Viral tests of Castillejo’s cerebral fluid, intestinal tissue and lymphoid tissue more than two years after stopping antiretroviral treatment showed no active infection.
Gupta said the tests uncovered HIV “fossils” — fragments of the virus that were now incapable of reproducing, and were therefore safe.
“We’d expect that,” he said.
“It’s quite hard to imagine that all trace of a virus that infects billions of cells was eliminated from the body.”
Researchers cautioned that the breakthrough did not constitute a generalised cure for HIV, which leads to nearly one million deaths every year.
Castillejo’s treatment was a “last resort” as his blood cancer would likely have killed him without intervention, according to Gupta.
The Cambridge doctor said that there were “several other” patients who had undergone similar treatment but who were less far along in their remission.
“There will probably be more but they will take time,” he said.
Researchers are currently weighing up whether or not patients suffering from drug-resistant forms of HIV might be eligible for stem cell transplants in future, something Gupta said would require careful ethical consideration.
“You’d have to weigh up the fact that there’s a 10-percent mortality rate from doing a stem-cell transplant against what the risk of death would be if we did nothing,” he said.
Castillejo himself said that the experience had prompted him to come forward and identify himself in order to help spread awareness of HIV.
This is a unique position to be in, a unique and very humbling position,” he told The New York Times.
Sharon Lewin, an infectious disease expert at the University of Melbourne and member of the International AIDS Society, said Castillejo’s case was “exciting”.
“But we need to also place it in context — curing people of HIV via a bone marrow transplant is just not a viable option on any kind of scale,” she said.
“We need to constantly reiterate the importance of, prevention, early testing and treatment adherence as the pillars of the current global response to HIV/AIDS.”
As doctors scramble to contain the fast-spreading coronavirus, a potent brew of anti-retroviral and flu drugs has emerged as a possible defence against the disease that has killed hundreds.
But the science is inconclusive on whether they are actually effective, and experts say a specific treatment could take years to develop.
Here is what we know — and don’t know — about the drugs deployed against the SARS-like virus.
Patients diagnosed with the common flu are often prescribed an antiviral drug widely known as Tamiflu.
But seasonal flu is “very different from the Chinese coronavirus”, said Sylvie van der Werf at the Paris-based Pasteur Institute.
So far the new coronavirus has infected tens of thousands worldwide and killed more than 420 people, mostly in mainland China.
Two weeks ago Chinese doctors confirmed they had been giving anti-HIV drugs to coronavirus patients in Beijing, based on a 2004 study published after the outbreak of Severe Acute Respiratory Syndrome (SARS) that showed “favourable” responses.
Used together, lopinavir and ritonavir decrease the amount of HIV cells in a patient’s blood, stripping back the virus’s ability to reproduce and attack the immune system.
Doctors have also combined the treatment with another anti-flu drug called oseltamivir, hoping the creative cocktail can sap the new coronavirus of its strength.
In Thailand, where there are now 25 confirmed cases, a 71-year-old Chinese patient returned a negative test within 48 hours of being given the three drugs.
But Thai doctors urged caution, saying the medicine needed to be given under supervision due to possible side effects.
Does it actually work?
In short, we don’t know for sure.
The 2004 study showed anti-retrovirals used on patients with SARS had “substantial clinical benefits”, experts in China said.
But random trials on 41 coronavirus patients had “limitations”, according to research published in The Lancet on January 24.
Doctors in Singapore — where there are 24 cases — have followed suit with the anti-retroviral treatment, said the country’s chief health scientist Tan Chorh Chuan, without going into details about the results.
Other studies looked “promising” and a clinical trial has started in Wuhan.
“These agents appear to be effective but we can’t be certain at the moment,” he said Tuesday.
What’s big pharma doing?
Biotech firms are working on a suite of treatment options.
California-based Gilead Sciences said they are working with Chinese authorities on clinical trials to determine if remdesivir — a drug used to treat SARS — is effective.
Meanwhile three teams around the world — in China, Australia and the Pasteur Institute in France — have now succeeded in cultivating the coronavirus in the laboratory.
That could lead to pinpointing its “Achilles’ heel” by understanding how it replicates in cells, said Christophe d’Enfert, the institute’s scientific director.
So what should you do?
The best approach for the general public is to try and “stay healthy” so your immune system can offer a robust response to the threat of the virus, said Singapore’s health minister Gan Kim Yong.
But for already infected patients, hospitals must provide support to prevent complications.
“Chances are if you already have underlying medical conditions… your defences are weak and your organs may already be impaired, and therefore the risk of death is higher,” he told parliament Monday.
Home remedies and quackery
Misinformation has proliferated online about home and traditional remedies.
A liquid made with honeysuckle and flowering plants used in traditional medicine was initially claimed to “inhibit” the virus, sparking frenzied buying in China.
But Chinese state media later sounded a more cautionary note, as researchers warned of potential side effects.
In India, where there are three reported confirmed cases, the government has touted ancient homeopathy and Ayurveda remedies as the answer.
The jury is out on the effectiveness, and doctors still recommended that patients be treated in a hospital.
Online posts erroneously identified saline as a coronavirus killer in Australia, while in Thailand social media suggested antiseptic should be sprayed in a person’s mouth.
The antiseptic company Betadine has refuted the claim.
The Senate on Wednesday urged the Federal Government to ensure adequate funding of the National Agency for the Control of Aids (NACA) for the fight and control of the spread of the Human Immunodeficiency Virus (HIV) in the country.
This was even as the upper chamber appealed to Nigerians not to stigmatize and discriminate against persons living with the virus, as well as advised all adults to know their HIV status by subjecting themselves to screening.
Accordingly, the Senate also called on the private Sector in the country to embrace the fight against HIV/AIDS by partnering with Government to fund the exercise.
These were resolutions reached by the Senate after consideration of a motion on “World Aids Day” sponsored by Senator Chukwuka Utazi (PDP, Enugu North).
Utazi, who brought forward his motion through orders 42 and 52 of the Senate Standing Rules, said there are fears in the HIV community that intervention funders may leave Nigeria soon for places where the deadly virus is yet to be kept at bay.
The lawmaker stated that such fears were as a result of the outcome of the report of the National HIV/AIDS Indicator and Impact Survey (NAIIS) unveiled by President Muhammadu Buhari in March, this year, which showed that prevalence of the virus in Nigeria dropped from 2.8 percent to 1.4 percent among adults aged 15-49 years.
According to Utazi, out of the 1.9 million people living with HIV in Nigeria, over a million of them are currently accessing treatment to achieve viral suppression.
He added, “With the appreciable control of this epidemic and the increasing expectation of further shrinking, the usual funding from foreign donors will equally shrink leaving Nigeria to battle in funding the management and care of people with HIV.”
Worried about the sustainability of the fight against HIV infection and control in Nigeria, the lawmaker posited that in a situation where funding partners pull out of the country, it would become imperative for private sector involvement in raising the needed fund to support government at the Federal and State levels.
A US pharmaceutical firm has identified a new subtype of the human immunodeficiency virus (HIV) and said the finding showed that cutting edge genome sequencing is helping researchers stay ahead of mutations.
The strain, HIV-1 Group M subtype L, has been recorded in three people from blood samples taken between the 1980s and 2001, all in the Democratic Republic of Congo, Abbott laboratories told AFP on Thursday.
To classify a new subtype, three cases must be discovered independently, according to guidelines issued in 2000.
Group M is the most prevalent form of the HIV-1 virus. Subtype L is now the 10th of this group and the first to be identified since the guidelines were issued.
Antiretroviral drugs, which today can reduce the viral load of an HIV carrier to the point at which the infection is both undetectable and cannot be transmitted further, have generally performed well against a variety of subtypes, according to research.
But there is also some evidence of subtype differences in drug resistance.
“Since subtype L is part of the major group of HIV, Group M, I would expect current treatments to work with it,” Mary Rodgers, a principal scientist and head of the Global Viral Surveillance Program at Abbott told AFP.
She added that Abbott was making the sequence available to the research community to evaluate its impact on diagnostic testing, treatments and potential vaccines.
“In an increasingly connected world, we can no longer think of viruses being contained to one location,” added Carole McArthur, a professor of oral and craniofacial sciences at the University of Missouri Kansas City, who co-authored a paper on the finding in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).
“This discovery reminds us that to end the HIV pandemic, we must continue to outthink this continuously changing virus and use the latest advancements in technology and resources to monitor its evolution,” she added.
The third sample was collected 18 years ago but was difficult to sequence given technical constraints at the time.
Abbott said the breakthrough was possible thanks to next-generation sequencing technology that allowed scientists to build up an entire genome at higher speed and lower cost.
“This scientific discovery can help us ensure we are stopping new pandemics in their tracks,” Rodgers said.
However, they found that fewer than 50 percent of young South Africans who present for HIV care go on to initiate antiretroviral therapy, which can prevent transmission and stops a patient from developing AIDS.
“Despite the upswing in numbers initiating therapy, barriers persist that prevent many adolescents from starting treatment,” said Mhairi Maskew from the University of Witwatersrand and the report’s lead author.
These include concerns about stigma, a pervasive sense that clinics cannot guarantee patient confidentiality and increased domestic responsibilities for young people, especially in families where children have lost parents to HIV and AIDS.
The study found that while those diagnosed with HIV were roughly split by gender, nine in 10 people actively receiving treatment were girls.
The authors said this was consistent with far higher rates of sexually-transmitted HIV infection in young women compared to young men.
AIDS deaths have declined globally since the peak of the epidemic in the early 2000s, but an international AIDS commission warned last year of a resurgence if the world’s booming adolescent population weren’t protected.
For just the second time ever an HIV patient is in sustained remission from the virus in what was hailed by experts Tuesday as proof that the AIDS-causing condition could one day be curable.
Ten years almost to the day since the first confirmed case of an HIV-infected person being rid of the deadly disease, a man known only as the “London patient” has shown no sign of the virus for nearly 19 months, doctors reported in the journal Nature.
Both patients underwent bone marrow transplants to treat blood cancers, receiving stem cells from donors with a genetic mutation present in less than one percent of Europeans that prevents HIV from taking hold.
“It is a landmark. After 10 years of not being able to replicate (the first case), people were wondering if this was a fluke,” said lead author Ravindra Gupta, a professor at the University of Cambridge.
“I think it is important to reaffirm that this is real and it can be done,” Gupta told AFP.
However, he was very careful at a press conference in Seattle, Washington, to avoid using the word “cure,” noting instead that “in another six months or two years, things will be clearer.”
Millions of people infected with HIV around the globe keep the disease in check with so-called antiretroviral therapy (ARV), but the treatment does not rid patients of the virus.
Close to 37 million people are living with HIV worldwide, but only 59 percent are receiving ARV. Nearly one million people die every year from HIV-related causes.
A new drug-resistant form of HIV is also a growing concern.
The first sustained remission survivor, announced in 2009 as “the Berlin patient” and later named as American Timothy Brown, was given two transplants and underwent total body irradiation to treat leukaemia — a process that nearly killed him.
Gupta said that although a second successful transplant did not constitute a generalised cure, it showed that even milder forms of treatment can achieve full remission.
“There are a number of learning points here,” he said. “Radiation has a lot of side-effects and leads to a delayed recovery of the bone marrow, so it’s really good that we’ve shown you don’t need radiation.
“The Berlin patient also had two rounds of chemotherapy because the first one didn’t work. We’ve done ours just once, and it was also a milder form, which is important,” he added.
‘HIV is curable’
Both patients received stem cell transplants from donors carrying a genetic mutation that prevents expression of an HIV receptor, known as CCR5.
The London patient was diagnosed with HIV infection in 2003 and had been on antiretroviral therapy since 2012.
Later that year, he was diagnosed with advanced Hodgkin’s Lymphoma, a deadly cancer.
He underwent a stem cell transplant in 2016 from a donor with two copies of a CCR5 gene variant, which is resistant to most HIV-1 virus strains.
“CCR5 is something essential for the virus to complete its life-cycle and we can’t knock out many other things without causing harm to the patient,” said Gupta.
“We know that CCR5 can be knocked out without any serious consequences because people are walking around without that gene.”
CCR5 was the target in the genome of the controversial gene-edited twins born last year in China, whose father is HIV-positive.
A second person is in sustained remission from HIV-1, the virus that causes AIDS, after ceasing treatment and is likely cured, researchers were set to announce at a medical conference Tuesday.
Ten years after the first confirmed case of an HIV-infected person being rid of the deadly disease, a man known only as the “London patient” has shown no sign of the virus for nearly 19 months, they reported in the journal Nature.
Both patients had received bone marrow transplants to treat blood cancers, receiving stem cells from donors with a rare genetic mutation that prevents HIV from taking hold.
“By achieving remission in a second patient using a similar approach, we have shown that the Berlin patient was not an anomaly,” said lead author Ravindra Gupta, a professor at the University of Cambridge, referring to the first known functional cure.
Millions of people infected with HIV around the world keep the disease in check with so-called antiretroviral therapy (ARV), but the treatment does not rid patients of the virus.
“At the moment, the only way to treat HIV is with medications that suppress the virus, which people need to take for their entire lives,” said Gupta.
“This poses a particular challenge in developing countries,” where millions are still not receiving adequate treatment, he added.
Close to 37 million people are living with HIV worldwide, but only 59 per cent are receiving ARV. Nearly one million people die every year from HIV-related causes.
A new drug-resistant form of HIV is also a growing concern.
Gupta and his team emphasised that bone marrow transplant — a dangerous and painful procedure — is not a viable option for HIV treatment.
But a second instance of remission and likely cure following such a transplant will help scientists narrow the range of treatment strategies, he and others said.
– ‘A cure is feasible’ –
“The second case strengthens the idea that a cure is feasible,” Sharon R Lewin, director of the Peter Doherty Institute for Infection and Immunity and the University of Melbourne, told AFP.
“We can try to tease out which part of the transplant might have made a difference here, and allowed this man to stop his anti-viral drugs.”
The International AIDS Society said in a statement Tuesday that results from the second patient “reaffirm our belief that there exists a proof of concept that HIV is curable”.
Both the London and Berlin patients received stem cell transplants from donors carrying a genetic mutation that prevents expression of an HIV receptor, known as CCR5.
“Finding a way to eliminate the virus entirely is an urgent global priority, but is particularly difficult because the virus integrates into the white blood cells of its host,” Gupta explained.
The study describes an anonymous male patient in Britain who was diagnosed with HIV infection in 2003 and has been on antiretroviral therapy since 2012.
Later that year, he was diagnosed with advanced Hodgkin’s Lymphoma, a deadly cancer.
He underwent a so-called haematopoietic stem cell transplant in 2016 from a donor with two copies of a CCR5 gene variant, a combination carried by about one per cent of the world population.
CCR5 is the most commonly used receptor by HIV-1.
People who have two mutated copies of CCR5 are resistant to most HIV-1 virus strains, frustrating the virus’ attempts to enter host cells.
As with cancer, chemotherapy can be effective against HIV as it kills cells that are dividing.
But replacing immune cells with those that do not have the CCR5 receptor appears to be key in preventing HIV from rebounding after the treatment.
After the bone marrow transplant, the London patient remained on ARV for 16 months, at which point ARV treatment was stopped.
Regular testing has confirmed that the patient’s viral load remained undetectable since then.
Timothy Brown, the “Berlin patient”, was given two transplants and underwent total body irradiation to treat leukaemia, while the British patient received just one transplant and less intensive chemotherapy.
“I did not want to be the only person in the world cured of HIV,” Brown wrote in a medical journal in 2015, explaining why he decided to reveal his identity.
The research team for the London patient will present their findings at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, Washington.
President Donald Trump’s call for a bipartisan commitment to eradicate HIV in the United States within a decade has been welcomed by experts and advocacy organizations even as major challenges remain.
Addressing Congress during the annual State of the Union speech, Trump hailed what he called recent breakthroughs which “have brought a once-distant dream within reach.”
“My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.
“Together, we will defeat AIDS in America and beyond.”
The announcement was reminiscent of his predecessor George W. Bush’s announcement at the same venue in 2003 of his President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion program considered a great success.
Though Trump’s plan doesn’t yet have a dollar figure, his Health and Human Services Secretary Alex Azar later added details to the president’s rhetoric: the initiative would reduce new infections by 75 per cent in the next five years and 90 per cent in the next 10, averting 250,000 cases in that span.
Such lofty ambitions would require a major acceleration of current efforts: some 38,000 people were infected with HIV in the United States in 2017, according to government statistics.
Human Immunodeficiency Virus infection can lead over time to acquired immunodeficiency syndrome (AIDS).
“We believe that it’s very much possible to end all new infections, in fact we believe it could be ended by 2025,” Jesse Milan Jr, the CEO of AIDS United, told AFP.
“This initiative, if properly implemented and resourced, can go down in history as one of the most significant achievements of his presidency,” added Michael Ruppal of the AIDS Institute.
But without a substantial budget to accompany the words, “it is a false and cruel promise,” David Holtgrave, Dean of the School of Public Health at the State University of New York added.
There is a broad consensus among experts that the pathway toward elimination involves boosting prevention in the most at-risk communities: gay men, blacks and Latinos and, to a lesser extent, intravenous drug users, who accounted for six per cent of cases according to the latest figures.
It will also require targeting of efforts in 48 counties, Washington, and San Juan, Puerto Rico where half of the new infections occur, according to Azar.
Prevention will involve stopping people who are currently infected from infecting others, which involves boosting access to antiretroviral medications — confirmed by studies to drastically reduce transmission rates to HIV-negative sexual partners.
This, however, would require infected patients to first know they are infected, a goal that is currently far from assured with an estimated 165,000 Americans unaware they are HIV positive.
Next, they would require access to antiretroviral therapy, a major challenge in a country where navigating the health insurance system can often be a bureaucratic nightmare and receiving even basic care is often a challenge, especially for lower income groups.
Currently, about one in two HIV-positive patients have their virus under control — with the government targeted a rate of 90 per cent.
Next comes Pre-Exposure Prophylaxis treatments (PrEP), revolutionary HIV prevention drugs meant for at-risk groups that have proven almost 100 per cent effective against infection but are greatly under-used.
Six years after their approval in the US, only 220,000 people took them in August 2018, according to prepwatch.org.
Officials estimate only 10 per cent of the 1 million Americans at substantial risk currently make use of the treatment.
Finally, condoms must once more come to the fore, according to Michael Weinstein, President of the AIDS Healthcare Foundation, who argues: “We’ve gone so totally in the direction of biomedical that we kind of wiped out any safer sex promotion.”
Two-thirds of infections occur among men having sex with men, a rate that shows no signs of slowing down. Blacks are particularly hard hit: a 2016 study by the Centers for Disease Control and Prevention found one in two gay black men will be infected by HIV in their lifetime.
Scientists and activists warned Friday that anti-abortion conditions attached to US aid under the Donald Trump administration threatened programmes to halt the spread of HIV.
Stipulations approved in Washington in May last year deny US aid to organisations which provide abortion information, referrals, or services – even with their own money.
This includes grants from PEPFAR, the programme set up under former president George W Bush in 2003 and now a major funder of HIV testing, counselling and treatment worldwide.
New rules under the policy dubbed “Protecting Life in Global Health Assistance” denies funding even to organisations that advocate for abortion services, International AIDS Society (IAS) president-elect Anton Pozniak said in Amsterdam.
Formerly known as the Mexico City policy, but commonly called the “global gag rule”, the conditions already applied to family planning clinics in the US.
“Now, under the Trump administration, it applies to almost all US global health bilateral assistance, including PEPFAR,” Pozniak told journalists on the final day of the 22nd International AIDS Conference in Amsterdam.
“The reach of this policy has been greatly expanded, and has the potential to roll back progress on HIV.”
The provisions mean that clinics which provide services such as HIV testing and family planning, must rescind US funding if they also provide abortion services, counselling or even referrals.
It will be too late
Jennifer Kates of the Kaiser Family Foundation, a health research NGO, said the altered policy “will likely affect hundreds of recipients” of US funding.
It is too early to quantify the effects.
“Some of the greatest harms of the global gag rule will not be measurable… until it’s too late to reverse course,” said Chloe Cooney of the Planned Parenthood Federation of America.
Clinics have already started to cut staff, some closing altogether, said Tikhala Itaye of the “Global She Decides Movement”, an activist group for women’s rights.
“Some of the girls accessing family planning services or contraception now cannot have those services,” she said.
Activists at the conference cited the global gag rule as one of many reasons for insisting that the IAS reconsiders its decision to host the next AIDS conference in San Francisco.
“No AIDS conference in Trump’s America,” said a coalition calling itself AIDS 2020 for All.
“The US government bans the entry of sex workers and people who use drugs, has criminalised immigrants and detained activists at airports, has denied HIV care to people in prison and immigrant detention centres,” it charged in a statement.
But Pozniak said the IAS was “committed to moving forward.”
“We’ve had conferences in many places of the world where there are issues,” he said.