Science has mutation, mistakes, and neglect to thank for recent treatments that have given HIV patients serious relief from what was once a death sentence with short fuse. Two new HIV advancements have surfaced, one altering genes to release patients from lifelong cocktail of anti-virus pills, the other reviving infected newborns with a more aggressive treatment. A cure or instant and permanent treatment is still far off, but could be quickly approaching once these methods can be put into regular practice.
First, there was a mutation. The foundation of this new technique is the slight difference of proteins on immune cells and can be found in one percent of Caucasians. People can inherit one gene mutation, which can delay HIV onset and progress for roughly two years. Or both parents can send on this gene to the child, in which case they have the stronger version of the mutation that appears to make the receptor the virus would cling to nonfunctional. This leads to the ability of completely preventing infection despite multiple exposures.
This was detected when “the Berlin patient” received bone-marrow for his leukemia. After the transplants, which included the donor’s DNA with both copies of the mutation, the virus disappeared. His immune system improved until he no longer had to take anti-viral drugs. Bone-marrow transplants are not an option for curing HIV due to the risk and expenses. But now, knowing about these proteins changes there can be a treatment to apply this to other patients.
Next, came a mistake. When cells become damaged by particular enzymes they undergo repair, but sometimes sewing themselves back together can have great consequences. Zinc-Finger nucleases is the name of the new process which acts as a scalpel on a molecular level. It cuts into cells and the result is certain genes being disabled. In this case, the HIV compatible gene is disabled and the genetic alteration was effective in 11-28 percent of treated cells in a recent study.
Published in New England Journal of Medicine, the small study conducted looked at 12 patients undergoing the gene-editing. Each participant had their white blood cells drawn, altered and allowed to heal themselves, then injected back into them with their new HIV resistance upgrade. Essentially, in 10 billion of the patients’ cells, the protein that HIV requires for circulation, connecting to, and invading cells was eliminated. The edited cells lasted significantly longer when six patients temporarily stopped taking their anti-viral medication.
This study was focusing on the safety of the technique and how well the patients received their upgraded T-cells. It was certainly a significant success but study of efficacy has not been conducted yet. Meaning, it is unknown if this will work for all 34 million people with HIV, or if it is more effective in certain groups. The end goal of this method is for the virus to take out the unedited white blood cells while the modified cells lead significantly longer lives and reproduce enough to stop HIV’s ability to effect the body.
But genetic alteration is not the only HIV advancement, a second revived newborn was reported. Thanks to highly accelerated treatment given to a baby more recently, it appears that the Mississippi baby relieved of HIV last year was not a fluke. There has been one more clear case of eliminating HIV from a baby, but also five reported in Canada and three in South Africa. Eradicating the virus from newborns could be a very real possibility for all 250,000 infected babies born every year.
The Mississippi Baby was started on drug treatment only 30 hours after birth, which was far different from standard procedure. Usually, one less medication was included in the cocktail and at a smaller dose. Only 18 months later, the mother stopped showing up to doctor appointments and neglected to medicate the baby. When the mother did attend an appointment, after a five month break without Mississippi Baby receiving treatments, the doctors were highly concerned. They predicted the child would be overwhelmed by the virus but all tests showed up clear if HIV signs. Mississippi Baby has remained virus free and is currently 3 years old.
This lead to both excitement for the future and skepticism that the baby had been even been infected at birth. But when that case was announced last year, Dr. Audra Deveikis was paying attention and when Long Beach Baby arrived, she knew what to do.
When Long Beach Baby’s mother arrived at the hospital ready to deliver the doctors discovered she had not taken the drugs prescribed to her which would prevent transmission during labor. The mother has advanced AIDS, leaving no room for error. Dr. Deveikis took blood samples then began the high dose of all three drugs . She admitted she was concerned about the medication’s toxicity. However, the mother’s case was so sever that the transmission of advanced AIDS outweighed that risk.
The blood tests Dr. Deveikis conducted eliminate any chance for skepticism, showing clear evidence of infection in both DNA and RNA of the Long Beach Baby, who remains healthy. The virus began disappearing at six days and was undetectable within the next five days.
Clinical trials are beginning soon and plan to include 60 babies. Treatment in newborns appears to control the virus before it can create reservoirs that would keep other patients from being called “cured.” Both HIV advancements, genetic alteration and the ability to revive newborns, will take time and testing, but both have begun improving lives already.
By: Whitney Hudson