That was recently Another case of recovery acquired immunodeficiency syndrome (lozenges). This is the fourth case to be documented Hematopoietic stem cell transplantation (HSCT), also known as bone marrow transplant.
But before the celebration, it is necessary to understand that these cases are “extreme cases”, because they do not apply within the standard routine of all people living with HIV (PLHIV). These four cases were transplanted not because of HIV, but because of other medical conditions, such as leukemia.
In these cases, despite the complications related to the procedure, there is a significant increase in survival due to the severity of the underlying hematological disease. However, taking advantage of the fact that the procedure was indicated for other reasons, donors were sought who could make AIDS treatment possible for the recipient patient.
How can treatment be achieved after transplantation?
After HSCT, all blood cells that are generated by the bone marrow begin to show characteristics of the donated progenitor cells. About 1% of the northern population is known to have a specific mutation that makes them resistant to HIV infection..
This prevalence is less in other regions of the world, that is, it is a rare case. It’s a relationship to the delta 32 gene that alters the cell receptor CCR5 that the virus uses to enter the cell, so it’s as if the virus doesn’t have the entry key.
So why not look for a donor who has this mutation for HIV who will undergo HSCT? Perhaps the recipient will begin to show this type of resistance to the virus that makes it difficult for them to progress. The first attempt was made in 2009, in the case known as the “Berlin patient”.
Surprisingly, This patient no longer showed signs of the virus after stopping antiretroviral therapy and was deemed cured of AIDS. The same procedure was done 3 more times, the last time in California at a hospital called “City of Hope”.
Advances in HIV treatment
The 40-year history of HIV, since the first case described in 1981, has been an impressive advance in medicine. Beginning in 1996, therapeutic regimens, formerly known as “cocktails”, due to the large amount of pills, allowed to control the virus, preventing the development of AIDS.
Since then, new treatment options have become available with fewer pills and fewer side effects, to the point where there are currently treatment options with just one pill a day.
Clinical advances are very important The life expectancy for an HIV-infected individual to begin treatment at age 21 at an early stage, when immunity has not yet been compromised, is 78.4 years versus 85.2 years for an individual without HIV. This difference, which in the 2000s was higher than in 20 years, is getting smaller.
The current major challenge is precisely the early detection of the virus to enable the maximum potential of treatment in preventing disease progression and limiting its transmission.
Unfortunately, the current treatment is still insufficient for a cure. Despite inhibiting viral replication in the blood, the drugs are unable to reach the so-called “HIV reservoirs,” the areas of the body where viruses are protected.
Even after many years of suppressive therapy, if it is stopped, the viruses that remain in these reservoirs multiply and attack the body’s defensive cells again.
See also: AIDS: The new, more aggressive alternative to HIV
Why is transplant not done for all HIV cases?
HSCT is not a simple procedure. Before transplantation, a treatment called a myelectomy is done, using drugs that simply kill bone marrow progenitor cells. This is necessary for the donor progenitor cells to adapt to the new marrow.
Obviously, this is a dangerous path, because the future, for a while, practically does not contain leukocytes, the cells that defend our body from the invasion of microorganisms. After transplantation, there is a risk that the donor’s cells will not adapt to the recipient’s marrow.
Even if the marrow is “taken”, there can also be problems such as graft-versus-host disease (GVHD), a condition in which new cells do not recognize some parts of the body. All these complications explain the high mortality rate, about 15%, from such a procedure.
Given the high complication rates of HSCT, it is clear that even with a chance of recovery, it is not reasonable to link all of these risks to a condition that can be controlled with easily taken medications and few side effects.
This is why treatment using this methodology should not be seen as the solution to all problems, but rather as an advance towards new treatment methods that could eventually be widely applied in the future.
Since it is not a simple procedure and carries many risks for the patient, transplantation should not be considered the first option in the search for a cure for AIDS.Source: Gettyimages
What are the potential treatments for treatment?
Hematopoietic stem cell transplant
We have already seen that HSCT is a system capable of treating HIV infection, but it is impractical in most cases because the risk does not favor this method.
Shock and kill
This is an option that focuses on the reservoirs of the virus. Medications are used to pack these “hidden” viruses into the bloodstream, making them vulnerable to antiretroviral drugs.
block and lock
It also acts on the reservoirs of the virus, but instead of stimulating the filling of the reservoirs into the bloodstream, it causes the virus to be ‘locked up’, that is, even as treatment is suspended by the patient, the viruses in the reservoirs stop expressing and do not spread.
With new modalities of genetic interventions such as zinc finger nuclease (ZFN), transcription activator-like exonucleases (Tallinn) and regularly assemble between protein 9 short alternating repetitive repeats (CRISPR/CAS 9), it is possible to act on the CCR5 receptor, modifying it to the point of blocking virus entry.
Intensification of antiretroviral therapy
There are reports of children born with HIV who, after stopping treatment a few years later, have remained in remission. It is not clear if these are cases of cure or ‘functional therapy’, while there are still viruses, but without clinical repercussions.
Vaccines are primarily used to strengthen the immune response to a specific infectious agent. However, HIV has some characteristics that make it difficult to produce vaccines, but there are fronts that have advanced in this regard. There is a possibility that HIV vaccines are not necessarily curable, but are used in a complementary manner to other therapeutic methods to achieve a functional or complete cure.
Regardless of the method of healing, there is likely not a short-term regimen that can be applied to everyone. It will take some time to assess the cost, risks, benefits and need for a framework for wide application.
HIV vaccines can be used as a complement to other treatments.Source: Gettyimages
If the disease is controlled, why wait so long for treatment?
What is the latest study on the treatment of high blood pressure? What about COPD? Is diabetes curable? Of course, there are lines of research to treat these and other chronic diseases that exist, but without major repercussions when progress is made.
This occurs because there are chronic diseases that are more socially acceptable, and others that are less acceptable. AIDS still carries a significant stigma that leads to discrimination, and few people living with HIV are entirely comfortable expressing the condition publicly. This problem is related to the sexual route of transmission of the virus and the fact that there is a greater risk of transmission during anal intercourse.
Men who have sex with men are more at risk. This should not be a barrier in terms of recognizing and confronting the problem, but in a society that does not tolerate diversity in terms of sexual orientation and practice.
According to the Human Dignity Trust, a foundation that advocates for the legal rights of LGBTQIAPN+ people globally, 70 countries criminalize private and consensual sexual activity of two people of the same sex, even if it is private.
Moreover, in 11 countries, the penalty can be death. How is information on the prevention and treatment of sexually transmitted diseases handled in the countries in which one lives under these legal requirements?
Hence, the cause of the healing euphoria is understandable. Of course, it would be something incredible and remarkable from a scientific and collective point of view, but it is still a kind of “crutch” for other structural problems that deserve attention.