Five years ago, the “Berlin patient” (a US Citizen living in Germany), Timothy Brown, had HIV and cancer of the lymph nodes, lymphoma, and needed a bone marrow transplant where he got his total body irradiated and given hemotherapy to knock out all his immune cells. Then he was given replacement cells from a person who had a delta 32 mutation and he survived this dangerous and expensive procedure. He was in the intensive care unit on absolute isolation so that he had only limited contact with any viruses, fungi, or bacteria. He improved to the point of leaving the hospital and actually spoke to HIV patients and providers in Palm Springs a couple of months ago.
His physician sought out a special donor with this mutation in hopes that his new cells would resist HIV infection. He still shows no HIV, even though it might have hidden in his brain, prostate, and other places (sanctuaries). The HIV had no place to multiply without being able to enter a CD4 cell or monocyte due to the mutation of the receptors on these cells. He is HIV free. I don’t know if he has antibodies, but he has no HIV in his system. Of course he has been practicing safe sex, duh!
The delta 32 mutation may have happened on its own and those that had it survived more than those who didn’t have it during the plague, smallpox epidemic, or flu epidemics that wiped out much of Europe many years ago. If you have a very low viral load or are undetectable without HIV medication, then please consider donating your bone marrow (through a needle) to those who are involved in a study (clinicaltrials.gov BMT CTN 0903) because you may have the delta 32 mutation.
Other Delta 32 Efforts
A research group from the University of Pennsylvania and San Francisco presented data recently showing that modifying a person’s CD4 cells and then transfusing them back, might make them like a delt-32 patient, i.e. HIV cannot enter these cells that grow into a large population. Some of the patients stopped their HIV medications and the viral load rose some and then dropped. They restarted the medication as a precaution while they figure this out more. Some investigators are considering giving light chemotherapy to these patients to give more room for the modified CD4s to grow.
HIV can be resting or active. The medications are only effective against the active virus. Some researchers are trying to get the HIV out of the resting state to eliminate it–like shaking the birds out of the bushes so you can shoot them. There are several studies attempting this strategy, but they are only in the preliminary stages.
They are still working on vaccines for functional cure (controlling the virus) or sterilization cure (eliminating the virus), and a preventive vaccine. They have hope.
Researchers at the University of Pennsylvania have introduced a different DNA into CD4 cells via a another retrovirus (different from HIV) and most of these patients have done quite well without any antivirals. This new implanted gene sets up these CD4 cells to kill any other CD4 cells that have HIV. These modified CD4 cells have lasted in some people for more than 10 years. The FDA is concerned that this other virus might cause a Tcell cancer, but so far, there is no evidence that will be a problem.
Hiv Home Test Coming?
This Oraquick test has passed the first of two steps to full approval. It takes 20 minutes and will cost less than $60. It tests for both types of HIV (1 and 2). There are concerns that this home test will encourage people not to use condoms or take their HIV medicine so they don’t pass it to others. For those who haven’t had counseling with the testing, then I recommend you get tested first by a professional the first time. There is a 7% chance this test is negative but you are really positive and there is a chance of 2 out of a thousand that it comes back positive when you are really negative. If it is positive, come on in to a testing site for confirmation. If you are confirmed positive then please see an HIV specialist; don’t be scared. We can only help you understand your options. Try to get over that emotional barrier, be an adult and deal with it, rather than let the virus have its way with your health. Also if you are positive, you are a walking vector for HIV, another reason to use a condom.
The FDA reviewers felt this home kit might prevent 4,000 new infections, lead to diagnosis in 48,000, and be used by up to 28 million people per year. That’s great news! This test is for those who are unable to go to a testing center and get the great counseling and testing available or who have the money for the test and are quite aware of what the counselors say.
Keep those questions coming.
Daniel Pearce, D.O., FACOI, AAHIVS
Associate Clinical Professor of Internal Medicine, Loma Linda University
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside