The Cure for HIV: Nurse Best Friend weighs in with Science

A few days ago I posted this article, with the great excitement that comes from being witness to something incredible and overwhelmingly hopeful.

For all intents and purposes, the human race has managed to cure HIV.

As summoned, Nurse Best Friend Stan rises to the occasion, dropping science and putting this incredible scientific miracle into the context of the pandemic. He's been hard at work doing HIV/AIDS Outreach with Public Health in two wildly different (and painfully similar) countries this year, so I figure he's the best qualified person I know. Also he's generally awesome.
This is what he graciously dropped in my facebook feed:

Here is the skinny on CCR5 receptors and HIV as I know it: 

Stan + Florence Nightengale = <3

The CCR5 receptor is kind of like a cellular appendix which the HIV 1 and 2 viruses attach to in order to gain entry into the CD4 (or white blood cell). HIV 1 and 2 cannot gain entry to the cell in people who have the genetic mutation which causes them not to create these "appendix" receptors, but they can still be infected with HIV. They will be asymptomatic, and probably will not develop AIDS for a very, very, very long time (if at all), but can still infect other people.   

As an example: there is a population of monkeys somewhere in South-central Africa in which there are no CCR5 receptors present and almost all members of this group have SIV (Ed. note: Simian immunideficiency virus--the most simple, crude description would be monkey AIDS). They live and reproduce and throw feces and do things monkeys tend to do--the virus and the monkeys basically live in symbiosis with each other.

Essentially, what they did with "THE BERLIN PATIENT" was replace his bone marrow stem cells (which are responsible for creating CD4 cells) with stem cells which carry the mutation that excludes the CCR5 receptor from the CD4 cellular envelope. Essentially, they wound up replacing his old CD4 cells with the HIV resistant kind.

Cool right? Yeah! 

Unfortunately, there are some huge  reasons why this isn't and won't be a viable option for anyone without a million zillion dollars or a research grant:

1) It's friggin expensive. Run a price check on bone marrow stem cells and let me know if you think there is enough money around to treat 33 million people, 60% of whom live in the most extreme poverty we can muster up on this planet. (Ed note: we're doing entirely too much mustering in this regard.)

2) It was friggin lucky. The sheer fact that they were able to find a bone marrow match is incredible, and the fact that they were lucky enough to find one with this already super-rare mutation is like getting struck by lightning while winning the lottery during a shark attack in Lake Simcoe.

3)It was friggin painful. Barring everything else, bone marrow biopsies and transplants are some of the most painful medical procedures known to modern science, burn debridement being the possible exception. 

4)Prevention is just better. Condoms cost cents to make, and a lifetime supply will cost less than this treatment will ever will. PLUS you get to have sex. Clean needles and education will always cost less than this sort of intense treatment, and be easier to implement, track and modify, and adapt interventions based on the needs of the clients.

I'm not denying that this guy is technically cured--if his ELISA is coming back negative, the antigen and antibody tests are negative, his CD4 count is high and viral load is undetectable (with negative antigen tests), then by all means, declare him cured. Kind of like how they cured that girl with rabies in the West (Ed. note: that was friggin interesting. Click that link). 

However, it doesn't mean that we've beat the disease. I would chalk it up as a lucky one-off that is a great avenue to begin some research. 

Apply this genetic knowledge to new HIV drugs and to the ongoing vaccine research, but it is not transferable, accessible or available to most people living with HIV.

In short: something awesome happened, that opens up further possibilities and avenues of awesome for the future. 

But we've still got a loooong way to go before we're out of the woods with HIV.

Huge thanks to Stan and SCIENCE!!