Wall Street Journal Says “Cure” for AIDS Stumbled Upon

Todd Heywood

Doctors in Berlin, Germany, are reporting that a 42-year-old American living in that city may have eliminated HIV from his body after a bone marrow transplant.

Doctors in
Berlin, Germany, are reporting that a 42-year-old American living in
that city may have eliminated the virus from his body after a bone
marrow transplant.

According
to the Wall Street Journal report, the man was suffering from leukemia
and AIDS, and while he continues to receive treatment for the leukemia,
the virus has not reappeared in his blood in 600 days.

Traditionally, when a person on antiretroviral medication to treat
HIV stops taking the pills, the virus bursts back with a flurry of
activity. But this unidentified patient stopped taking the medication
and has not had any evidence of the virus in his blood since.

The report explains that doctors believe this is due to the man’s
leukemia doctor’s use of bone marrow from a donor who had genetic
immunity to HIV infection.

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The development suggests a potential new therapeutic
avenue and comes as the search for a cure has adopted new urgency. Many
fear that current AIDS drugs aren’t sustainable. Known as
antiretrovirals, the medications prevent the virus from replicating but
must be taken every day for life and are expensive for poor countries
where the disease runs rampant. Last year, AIDS killed two million
people; 2.7 million more contracted the virus, so treatment costs will
keep ballooning.

So what does this case indicate to experts? The Journal reports:

While cautioning that the Berlin case could be a fluke,
David Baltimore, who won a Nobel prize for his research on tumor
viruses, deemed it “a very good sign” and a virtual “proof of
principle” for gene-therapy approaches. Dr. Baltimore and his
colleague, University of California at Los Angeles researcher Irvin
Chen, have developed a gene therapy strategy against HIV that works in
a similar way to the Berlin case. Drs. Baltimore and Chen have formed a
private company to develop the therapy.

“Sounds like good news so far — I’d be hesitant to call it a cure,”
Mark Peterson of the Michigan Positive Action Coalition, or MI-POZ, a
group of politically active HIV-positive people in Michigan, said in an e-mail. Peterson went on to say that the news
underscored the importance of research into a specific class of drugs
that stop the virus from invading human cells in the first place.

This is possibly very important news in the fight against HIV.

When antiretrovirals were first introduced, and viral loads (the
number of viral particles in the blood) were found to have been
suppressed to undetectable, doctors thought that eventually cells
harboring HIV would die off and the person would be HIV-free. That did
not happen. Researchers discovered that the virus incorporated itself
into the genetic makeup of the infected person and waited for the
opportunity to reignite the infection.

But in 1996, researchers also made another startling discovery, the Journal reports:

…researchers discovered that some gay men astonishingly
remained uninfected despite engaging in very risky sex with as many as
hundreds of partners. These men had inherited a mutation from both
their parents that made them virtually immune to HIV.

The mutation prevents a molecule called CCR5 from appearing on the
surface of cells. CCR5 acts as a kind of door for the virus. Since most
HIV strains must bind to CCR5 to enter cells, the mutation bars the
virus from entering. A new AIDS drug, Selzentry, made by Pfizer Inc.,
doesn’t attack HIV itself but works by blocking CCR5.

Craig Covey, executive director of the Midwest AIDS Prevention
Project based in Ferndale, said he had not heard anything about the
case or the reports, and was unable to comment.

News Human Rights

Louisiana Is ‘Ground Zero’ for HIV, Incarceration Crises, Report Says

Kanya D’Almeida

Both of these epidemics disproportionately harm Black people, who account for 70 percent of new HIV infections in Louisiana and 66 percent of the state’s prisoners.

Thousands of prisoners in Louisiana’s county jails are routinely denied access to HIV testing and treatment, with five of the state’s 104 jails offering regular tests to inmates upon entry, according to a new Human Rights Watch (HRW) report.

The same people who are at the highest risk of HIV—people of color, sex workers, and low-income communities, for instance—face disproportionate incarceration rates in Louisiana, meaning that low-income people of color, and especially Black people, are bearing the lion’s share of the burden of inadequate HIV care in county jails, called “parish” jails in Louisiana.

Louisiana has the nation’s second highest rate of new HIV infections, and the country’s third highest rate of adults and adolescents living with AIDS, according to the report. The state has the highest incarceration rate in the nation, locking up an estimated 847 people per 100,000 residents, compared to the national average of 478 prisoners per 100,000 people. On any given day, there are roughly 30,000 people in Louisiana’s parish jails, contributing to an incarceration rate that is 150 percent of the national average.

Many of those whose treatment has been interrupted while in jail were arrested for minor, non-violent crimes, per HRW.

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Both of these epidemics disproportionately harm Black people, who account for 70 percent of new HIV infections in Louisiana (compared to 24 percent for white people), and 66 percent of the state’s prisoners—even though Black people account for 32 percent of Louisiana’s 4.6 million residents.

“This is not a coincidence,” Megan McLemore, a senior researcher at HRW and author of the report, told Rewire. “The history of the state of Louisiana has been, to say the least, disturbing in relation to African Americans.”

HRW interviewed more than 100 people for the report, from formerly incarcerated people to medical staff in parish jails to HIV service providers. What they found was a pattern of rights violations, including the failure of most parish jails to comply with recommendations by the Centers for Disease Control and Prevention that all inmates be tested for HIV upon entry at a corrections facility.

Jail officials reportedly told HRW that they avoid testing because they can’t afford to treat those who test positive: a course of medication for a single patient can fall in the range of $23,000-$50,000 per year. But the HRW report claims that failing to conduct proper testing, interrupting patients’ treatment plans, and neglecting to provide linkages to treatment centers for people leaving jails could end up costing the state much more in the long run.

Strict adherence to antiretroviral medication regimes has been found to greatly enhance successful management of HIV, the report said, by strengthening a person’s immune system and decreasing the amount of virus in the body, thereby reducing the risk of transmission. By denying inmates access to their medications, Louisiana’s parish jails are contributing to an already grave epidemic: the state is home to more than 20,272 people living with HIV, with half of them diagnosed with AIDS, according to the report.

Jail officials’ behavior heightens the stigma around HIV, advocates said. McLemore told Rewire that Louisiana’s inmate population represents some of the country’s most vulnerable and heavily policed communities.

“These are people who are already stigmatized—add HIV, and the situation becomes almost unbearable. So when jail officials intentionally avoid or neglect testing and treatment, they are not only adding to that stigma, they are actually being discriminatory,” McLemore said, adding that some caseworkers claimed their HIV-positive clients avoided disclosing their status to jail staff because they had no assurance that it would guarantee care.

Darren Stanley, a case manager at the Philadelphia Center in Shreveport, told HRW that half his clients have spent time in jail, and the majority of them are denied their medications on the inside. One of his clients, who spent three weeks in the Caddo Parish Prison in 2013, paid the ultimate price.

“I tried to get in touch with him but he was very sick without his medications,” Stanley told HRW. “He died of AIDS two weeks after he got out.”

A formerly incarcerated woman named Joyce Tosten who spoke to HRW claimed parish jail officers informed her that she would need to have her mother deliver any necessary HIV medications to the jail. But she couldn’t call her mother because she didn’t have phone privileges at the time. Other sources alleged that even when family or friends brought medications to the jail, they were never delivered.

The problem does not stop at incarceration. According to HRW, “release from parish jail is often a haphazard process consisting of whatever is left of their medication package, a list of local HIV clinics, or nothing at all.”

The report includes a series of recommendations such as setting aside adequate funding for HIV testing and care, training jail staff on effective treatment and management options, and strengthening links with local care providers and community-based centers for returning citizens.

Deon Haywood, executive director of Women With A Vision (WWAV), a New Orleans-based grassroots health collective responding to the HIV epidemic in communities of color, told Rewire that HRW’s recommendations were “spot on.”

“They speak to the conditions we have seen in the community for the past 26 years,” she said. “Through my work at WWAV and other New Orleans agencies, I’ve witnessed the failure of incarceration to better the community. We urge Louisiana to invest in education rather than criminalization, and shift the state’s resources and policies towards solutions that address the systematic inequalities that poor communities of color face on a daily basis.”

HRW’s report adds to a list of woes that Louisiana residents confront on a daily basis. The state recently ranked last on a nationwide index measuring social justice issues like poverty and racial disparities.

CORRECTION: This story has been updated to reflect Louisiana’s correct incarceration rate.

News Sexual Health

Teenager in France in Remission From HIV Infection Without Medication for 12 Years

Martha Kempner

Researchers from France recently presented the results of a case in which a girl born with HIV who was treated early in life has remained in remission without medication for 12 years. Experts are excited but cautious because similar cases have ended with HIV being detected in patients blood again.

Researchers at an IAS conference on HIV pathogenesis, treatment, and prevention held last week in Vancouver presented the case of an 18-year-old girl in France who was born with HIV but appears to be in remission, despite not having taken medication since the age of 6.

Though there is no cure for HIV, there have been some cases in which the virus remains undetectable in someone’s blood without intervention. Researchers hope that by studying this young woman, they can understand how this is possible and how they can replicate it.

The young woman was born to an HIV-positive mother and given an antiretroviral drug called zidovudine for six weeks beginning soon after birth. The original goal of treatment was to prevent her from becoming infected with HIV, but when her viral load got higher, doctors decided to change course and start her on a combination of four drugs.

She stayed on this regimen for years. At some point between the ages of 5 and 6, however, her family decided to discontinue the drugs, though they have not publicly explained why.

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Doctors saw her again at age 6 and were surprised to find that the girl had an undetectable level of HIV in her blood, despite the lack of medication. Twelve years have gone by and the young woman is still not taking medication and still has an undetectable level of HIV.

There are other patients for whom this has happened, at least in the short term. For example, Rewire has written about an infant known as the “Mississippi Baby,” who was born to an HIV-positive mother and given powerful antiretroviral drugs just 30 hours after birth. The baby remained on these drugs for 18 months, at which time her mother stopped bringing her to the clinic.

The next time the doctors saw her, the baby had no detectable virus in her blood stream despite having been off of the medication for five months. She remained off of her medication and continued to have an undetectable viral load until just before her fourth birthday, when a routine test once again found HIV in her blood.

Asier Sáez-Cirión, the researcher who presented this new case last week, also worked with a group of adults in France known as the Visconti patients. These 20 individuals were treated for HIV soon after infection but stopped taking their drugs three years later. Most18 of them—were able to keep the virus at bay on their own; they have an average of ten years in remission.

Some refer to this kind of remission as a “functional cure” because it does not eliminate the virus from the body, but it prevents the virus from causing harm.

A “true cure” would eradicate HIV from a person’s body. This has proven extremely hard to do because of so-called viral reservoirs—cells in which HIV “takes up residence” and can hide for decades. Functional cures are easier to achieve. In fact, in some ways, antiretroviral therapy can be considered a functional cure because it keeps viral loads down and prevents the virus from causing harm. For most people, however, these drugs will stop working as soon as they are discontinued.

Researchers do not yet know why some patients, like this French teenager or the Visconti patients, are able to continue the success of the drug therapy on their own. These patients seem to share immune gene variations that predispose them to severe early HIV infections. Researchers aren’t sure how this helps them later, but one theory suggests that it may cause their infections to be noticed, and therefore treated, sooner than most people.

Early treatment seems to be a key to functional cures, but it’s also a stumbling block to widespread use of these therapies, because most people don’t know they are infected until months after it happens.

“We are learning from this patient, that’s why it’s so exciting. We are learning clearly which kind of response the strategy for the future should use,” Françoise Barré-Sinoussi, who is credited with co-discovering HIV in 1983 and won a Nobel Prize for her research, said in an interview with CNN. She works at the Institut Pasteur with Sáez-Cirión. “This is critical if we want to make progress in the field of remission in the future,” added Barré-Sinoussi.

Many in the field seem to be tempering their excitement after what happened with Mississippi Baby and other cases in which functional cures ultimately stopped working. Moreover, experts are warning parents that most children will not fare well off of their medication.