Dear Dr Laura,
I was diagnosed with HIV last year and I’m undetectable on treatment. I’ve been reading about the 2nd HIV cure this week – is this something I can access? Will I be able to stop my treatment? Thank you.
There has been a lot of press coverage about this case and for good reason – this is only the 2nd case in the world where somebody with HIV has stopped their HIV, and stayed off treatment, with absolutely no sign of HIV emerging.
Before this case from London there was only one case of ‘cure’ in a man called Timothy Brown, also known as “The Berlin Patient”. Coincidentally Timothy Brown was originally from Seattle, the same city that hosted the conference where the 2nd cure case was presented this week.
Brown was diagnosed with HIV in 1995 and started HIV treatment. In 2006 he was diagnosed with leukaemia (a type of blood cancer) requiring two bone marrow transplants and strong radiation treatment. His doctors chose a bone marrow donor with a genetic change that makes people pretty much resistant to getting HIV. He stopped his HIV treatment, the viral load never rebounded and, indeed, after very extensive testing, there is no sign of the virus in the body after several years off HIV treatment since, so he is considered cured.
The case presented most recently is from London and here the patient was also undetectable on treatment then developed lymphoma, another type of cancer. Again, the doctors chose a donor with the same genetic change but without radiation treatment. After the transplant there was no evidence of HIV so HIV treatment was stopped and, 18 months later, there is still zero sign of HIV. It may be a bit early to call this a cure but it’s certainly what we would call a ‘long term remission’ off treatment and longer-term follow-up is crucial.
Now, despite these 2 cases, this is not a realistic HIV treatment. The risks of bone marrow transplant are significant including death and serious infection. Also in other cases where people with HIV who’ve had bone marrow transplant the virus rebounded off HIV treatment so this certainly hasn’t worked every time.
The challenge for HIV cure is that the virus hides in cells that are effectively ‘sleeping’ and is hidden from standard HIV drugs – if you stop treatment the virus in these cells eventually reappears. There’s a lot of research into drugs that can ‘wake up’ the resting cells and reveal the hidden virus but it’s early days and a trial presented at a big conference in Amsterdam last year was not successful – we have some way to go.
The only way to truly know if a cure has been successful is to stop HIV treatment and some people argue that with effective, easy to take HIV treatment, normal life expectancy and knowledge that people on successful HIV treatment cannot pass the virus on (UNDETECTABLE= UNTRANSMITTABLE, U=U), the risks of stopping treatment may not be worth it.
Others think the risk is worth it to further our understanding of whether cure treatments will work and some studies of people with HIV show many are willing to take that risk. In my opinion, as long as the pros and cons are explained and people are monitored closely, then they should be offered the opportunity to take part in cure trials if they wish to.
For you though, I would advise a definite no to stopping your HIV treatment. If you started early you may be in a good position for future trials so make sure your clinic keeps you informed about any that you may be eligible for. The risks of stopping treatment include feeling unwell when the virus increases, developing resistance to your HIV medication and there is a risk you could pass HIV on to sexual partners. It’s an evolving field and one day we may well be able to offer people cure treatments but, in my view, that’s still many years away.
The Boyz Doc is Dr Laura Waters, an HIV and sexual health consultant at the Mortimer Market Centre in central London. Dr Laura answers your questions every week in Boyz. If you have a question for Dr Laura please email her at firstname.lastname@example.org