River Deep, Mountain High: Pathways towards a cure for HIV
Speakers: Dr. Katharine Bar and Moses Supercharger
Moderators: Danielle Campbell and Michael Louella
Wednesday 16 February 2022
A new “cure” case
Katie Bar led the discussion on HIV cure. As announced on Tuesday at CROI, a woman of mixed race appears to be the third person ever to be cured of HIV, using a new stem cell transplant method involving umbilical cord blood. The woman was diagnosed in 2014 with leukemia and was assigned to the procedure. The patient has now had over 14 months in HIV remission, without rebounding.
In stem cell transplants, it is a challenge to find the correct CCR5 cells for many different population groups. The new case is particularly important, as the woman in remission is of mixed race. Non-white people are less likely to find a stem cell donor for CCR5 cells, which is why they used umbilical cord blood as this doesn’t have to be close a match as when the donor is an adult. The cord blood then had to be supplemented with stem cells from close relatives to be used. Using cord blood in this way opens this type of treatment up to people who are not of Northern European descent, meaning other communities can also participate.
Of course, the complex procedure is not ready to be used for the vast majority of individuals, however the news is promising in terms of development in cure strategies.
Post Treatment Control: another strategy
Another cure development strategy was discussed, following the new evidence from a Danish cohort led by Ole Søgaard. The multi-national study showed the importance of an early start of ART and the use of a mix of strategies such as different combinations of ARVs, broadly neutralising antibodies (bNAbs) and anticancer agents, to limit the establishment of the reservoirs and to keep the viral replication under control.
The takeaway points of the study are that though it is not a perfect strategy, it does lead to reduced sizes of reservoirs, and potentially leads to an immune system that is more capable of keeping the virus in check, it is a reasonable way to intervene and is not limited to individuals with unique cases. By using these antibodies at different timepoints, it is possible to start chipping away at the reservoir, and in turn see HIV remission in larger groups of people.
Define ‘cured’?
The community had a discussion over the wording used when referring to HIV Cure/ remission. In some media articles, this newly found case is referred to as a “possibly cured”, perhaps due to caution around prematurely using the term ‘cure’ in cases of ART-free HIV remission. The topic on language was previously covered in a pre-CROI community session on HIV Cure Definitions. The community welcomed the idea of having a standard definition on what ‘cure’ really means, and that community spaces within conferences were a good place to find consensus on this.
“A cure without us, will not be our cure”
It is clear that synergies between different areas of research and advocacy including cure, vaccines and prevention are the way for the future. In this context, the community reiterated the non-negotiable need for participation of people living with HIV, at all stages of cure-related clinical trials. We need more cure fellowships, cure academies and to be involved in more cure community advisory boards with pharma. Cure language also needs to be broken down and made accessible. Collaboration, combination and joint effort are crucial.
Resources
Click here to watch the recording of the session!
Click here for a copy of the MBC Chat for this session where you can access links to articles and opinions from attendees of the session.
NEXT MBC, Session #3:
Join us for our next Margarita Breakfast Club session on Tuesday 22 February at 7:15 am Mountain/Denver time (15:15 CET) to discuss ageing with HIV, frailty and comorbidities.
Register here:
https://zoom.us/meeting/register/tJwodeCpqDMiGdTR0U16wmo7GtlV1OPOZwQE
More about the MBCs: https://www.eatg.org/events/margarita-breakfast-clubs-at-croi-2022/
Get involved
Are you living with HIV/AIDS? Are you part of a community affected by HIV/AIDS and co-infections? Do you work or volunteer in the field? Are you motivated by our cause and interested to support our work?
Subscribe
Stay in the loop and get all the important EATG updates in your inbox with the EATG newsletter. The HIV & co-infections bulletin is your source of handpicked news from the field arriving regularly to your inbox.