Views on the News: AIDS Cure
For the second time in the history of the AIDS epidemic, a patient carrying HIV was successfully cured of the disease in London. While researchers have described this as a long-term remission of the disease instead of a cure, many are optimistic that the therapies the patient underwent could pave the way for the future of AIDS treatment, and might lead to an eradication of the disease altogether. However, this “cure” requires the use of a bone marrow transplant, a painful procedure for donors that can lead to long-term discomfort. Do you think that bone marrow transplants should continue to be used on a large scale in the search for a cure for AIDS? Should HIV research funding be directed to this method or to other experimental therapies?
Prof. Donald Shepard (Heller)
Advances in anti-viral therapy and more widespread use of treatment and prevention have almost halved global HIV/AIDS deaths over the past decade. Nevertheless, the World Health Organization estimated that 0.94 million people died of HIV/AIDS-related illnesses globally in 2017. As well as more complete application of existing therapies, this disease needs new treatments. The “London patient,” who received bone marrow transplant for cancer treatment, achieved remission of his HIV/AIDS as an additional, dramatic benefit. However, this experimental therapy is expensive and replete with side effects. Furthermore, according to Gates Foundation Advisor Dr. Mike McCune, it could address only half of HIV/AIDS infections (those using CXCR5, not CXCR4, cells). Since the London patient has been off anti-viral treatment and free of HIV/AIDS for only 12 months, his long-term prognosis is still unknown. For other diseases, such as prostate cancer, where invasive treatments have uncertain long term benefits, complications, and side effects, randomized trials have provided key data. Similarly, this bone marrow treatment deserves measured expansion with careful documentation, and, if still promising, a randomized trial to assess its true, long term value and applicability.
Prof. Donald Shepard is a member of the Schneider Institutes for Health Policy at the Heller School, specializing in Health Economics.
Prof. Ian MacPherson
For those living with HIV who are successfully undergoing anti-retroviral therapy (ART) and are otherwise healthy, the risks of a bone marrow transplant are probably not worth the potential gain in quality of life. However, complications such as ART-resistance occur in a subset of patients and they may benefit greatly from such a procedure. Additionally, technological advances in the bone marrow transplant procedure itself may minimize risk and discomfort enough to make it a viable option for otherwise healthy individuals living with HIV. With respect to the scale of current research efforts, it is quite low given the criteria for such a procedure (HIV-positive individual in need of a bone marrow transplant with a matched donor having HIV-resistant T-cells).
Ian MacPherson is an assistant professor and researcher in the department of Tropical Medicine at the University of Hawaii, Manoa.
Shoshana Finkel ’20
To a layperson, it may seem like there should already be a cure for AIDS - we have vaccines and antiviral drugs for so many of the world’s most deadly viruses! But because of the nature of the way HIV attacks the immune system, any of these treatments would be rendered useless with HIV in the bloodstream. Until we know more about this “cure”, here’s what is still recommended by the public health community: vigilant education on how to prevent the spread of HIV using safe sex practices, and making medicine like PrEP, that prevent HIV infections from advancing to AIDS, more widely accessible to the HIV positive population. Am I excited about the prospect of an AIDS cure? Absolutely. But we shouldn’t stop making sure we are preventing the spread of HIV and the advancement of AIDS in patient’s bodies. We can’t drop the ball on those vulnerable populations who won’t immediately have access or afford these expensive treatments.
Shoshana Finkel is a Health, Science, Society, Policy Major and the Undergraduate Departmental Representative for the Yiddish department.