Woman’s case raises hopes of functional HIV cure

As the first woman in the world is believed to be cured of HIV, could this pave the way for a future cure against the virus? 

The news of the first female patient and the third person in the world believed to be cured of HIV was received with great enthusiasm.

The woman from the US was being treated for leukaemia when she received a stem cell transplant from a donor with natural resistance to the Aids-causing virus and she has now been free of HIV for 14 months.

The BBC health correspondent, James Gallagher, called it ” a genuinely remarkable story and a cause for celebration”. However, scientists believe that the cord blood transplant would be too risky for most people with HIV.

Only two other patients in the world were cured of HIV following a stem cell transplant. Both of them had cancer and curing their HIV was never the primary goal due to the side effects of the transplant.

Sharon Lewin, president-elect of the International Aids Society, admits that the procedure could not be a viable cure, but she explains that this new case “has consolidated our understanding of how a cure can be achieved”.

“There is a small group of people with HIV who get blood cancer and need a bone marrow transplant and this approach will be far more accessible to them,” she says. “However, the big question is, what does it mean for everyone else, for the 37 million people living with HIV?”

Experts are now looking at ways to make the cells resistant to HIV using less invasive procedures.

“The focus now is on how we can generate HIV resistant cells without a blood transplant,” adds professor Lewin.

Gene therapy is one strategy that is being investigated. This means that in the next 10 years we could see “gene scissors” being used to remove the receptor for HIV, mimicking what happened to the woman cured, but without the need of a cell transplant.

“Several reports of cures interventions in animal models seemed to have worked in the past,” professor Lewin says. “They’re using interventions in combination, flushing out the virus as well as boosting the immunity and we’re now in the era of testing some of them in people.

“I think over the next few years, we’ll know whether those combinations allow at least some people to safely stop antiretroviral therapy.”

A potential cure for HIV would have multiple benefits, not just financially, for those who can’t afford the huge costs of a lifelong antiretroviral treatment, but also socially.

“The stigma around HIV is a great barrier for people to seek out healthcare for both treatment and prevention,” explains Lewin.

“People living with HIV really do want a cure. They don’t want to be on lifelong treatment and I think that a cure will indeed make a difference. People would come to get tested and go on treatment, because they know there’s a cure rather than lifelong treatment.”

Another HIV cure would involve a therapeutic vaccine, as opposed to a standard vaccine, that would stimulate the immune system of someone already infected with HIV.

But even though we do not yet have a vaccine, there are many things we can do to prevent infection and minimise transmission. Condoms, tablets and injections of antiviral drugs, for example, have been very effective in preventing infection.

Professor Lewin says that: “Soon there’ll be implants and vaginal rings and a whole range of HIV prevention tools, especially for those at a higher risk of infection.

“But I think, more importantly, people need to know about how HIV is transmitted, the risks and how to prevent it,” she adds.

“We should be empowered to navigate sexual choice and prevent infection through behavioural modifications. For young women, I guess that’s probably the most important thing.”