It was an exciting moment when doctors believed, even for just a short period of time, that a cure for HIV was on the horizon.
When it came to potential so-called HIV “cures,” first it was the Berlin Patient — a man who suffered both from HIV/AIDS and acute myeloid leukemia and was cured after receiving a bone marrow transplant that contained a genetic mutation — and then it was the Mississippi baby to make headlines. The baby was an especially significant moment for the HIV/AIDS cure frontier, because it meant that children born to HIV-infected mothers could potentially be saved from a lifetime of disease as long as they were blasted with antiretroviral therapy within 30 hours of their birth.
It was disappointing, then, for doctors to discover about a month ago that the child hadn’t been cured at all; the virus had been detected in the baby’s bloodstream. Even worse, the virus appeared to be replicating.
Destroying Infected Memory Cells As Road To Remission
But many of these HIV/AIDS doctors and researchers aren’t giving up quite so soon. Despite the discouraging blow, Dr. Robert Siliciano and Janet Siliciano, both of Johns Hopkins Medicine, say that this is just the beginning of a “new chapter” in HIV/AIDS research and that there are plenty of lessons to be learned from the Mississippi baby and these other near-cure cases. In commentary published in Science, they note that scientists can glean hope and knowledge from the fact that the Mississippi baby was able to live for so long in remission — and this is a goal in itself. Lengthy remission “will be the next frontier in HIV treatment,” they write.
“Heartbreaking as these three cases are clinically, they provide a dramatic illustration of the real barrier to an HIV cure and illuminate important therapeutic strategies,” Dr. Robert Siliciano said, Medical News Today reported.
The new frontier may lie in CD4+ T cells, which are memory immune cells; the Silicianos described it as the “single most important hurdle to eradicating HIV.” These CD4+ T cells fight foreign invaders that they’ve experienced previously; but the sneaky HIV virus is able to hide within them and trigger replication. And they’ve been the source of the return of the HIV virus in all of the cases where doctors believed the patient had been cured, or at least been in remission.
“Clearly, neither approach managed to eradicate all latently infected cells, and what these cases underscore is the ability of even a few such cells to rekindle infection after prolonged remission,” Siliciano said. So an ultimate cure — or at least a way for a longer remission — could be found by destroying infected memory cells. In addition, regular blood monitoring to better keep track of T cells will also be an important step.
"These cases paint several clinical scenarios where a substantial reduction of viral reservoirs would allow some patients to come off treatment for prolonged yet uncertain periods of time, but they also raise the critical question of how to best monitor them for relapse so they can resume therapy swiftly when the virus rebounds," Janet Siliciano said, according to HUB, Johns Hopkins University's news network.