HIV Not Cured in “Boston Patients”
As Timothy Henrich of Boston’s Brigham and Women’s Hospital reported at a major international AIDS conference in 2013, the two “Boston Patients” underwent a transplant procedure similar to the one that cured “Berlin Patient” Timothy Brown but continued to take antiretroviral therapy. Up to four and a half years following the transplants, the research team could detect no HIV in peripheral blood or (in one patient) gut tissue using highly sensitive tests. “Because of these findings, we felt it was justified to take the patients off antiretroviral therapy. In essence, we want to do an analytical treatment interruption,” said Henrich in a July 2013 press conference. “We want to stop therapy and see what happens. Does the virus come back?”
Unfortunately, the virus did return, Henrich shared in a presentation on December 5 at the International Workshop on HIV Persistence During Therapy in Miami. As reported by Kay Lazar in the December 6 Boston Globe, researchers found evidence of HIV in one individual in August and in the second man in November; both resumed antiretroviral treatment.
The re-emergence of the virus points to the need to better understand viral reservoirs, cells that harbor HIV’s genetic material but not actively replicating virus. Because current antiretroviral therapies work not by destroying the virus but by interrupting its life cycle, the HIV material in these reservoirs is unharmed by antiretroviral drugs. Cure researchers are seeking ways to target these reservoirs, which are a source of viral “persistence” even when HIV treatment is working.
What do these disappointing results mean for cure research going forward? “This suggests that we need to look deeper, or we need to be looking in other tissues . . . the liver, gut, and brain,” Henrich told the Boston Globe. “These are all potential sources, but it’s very difficult to obtain tissue from these places so we don’t do that routinely.”
“This is certainly telling us a lot about persistence, what we need to do, and how low we need to drop the levels of HIV reservoirs in order to allow patients to achieve remission,” added Dr. Katherine Luzuriaga, professor of molecular medicine, pediatrics and medicine at the University of Massachusetts Medical School. Luzariaga is part of the research team following a Mississippi child who received antiretrovirals unusually soon after birth, stopped HIV treatment, and today shows no detectable HIV in blood tissues at roughly two and half years of age.
The Boston Globe article is excerpted below and available in full online.
By Kay Lazar
December 06, 2013
Boston researchers are reporting the return of the HIV virus in two patients who had become virus-free after undergoing bone marrow transplants, dashing hopes of a possible cure that had generated widespread excitement.
The rebound of the virus shows its persistence, and that it can hide in places in the body where it’s hard to find, said the lead scientist, Dr. Timothy Henrich of Brigham and Women’s Hospital. But he said the team has gleaned significant clues from the cases for designing next-generation treatments to battle the virus, which causes AIDS.
Henrich, who presented the preliminary findings Thursday at an international conference of AIDS researchers in Florida, said doctors pinpointed signs of the virus in both patients, who had beaten back the infections to undetectable levels earlier this year. The patients underwent bone marrow transplants several years ago for cancer, and had since stopped their powerful antiretroviral medications, which are typically given to those infected with the virus to keep it in check.
Other researchers who heard the presentation said the results were disappointing but the Boston team’s approach and data will dramatically advance strategies for battling HIV.
Henrich, a Brigham infectious diseases associate physician, said in an interview that the researchers decided to release their initial findings, before analyzing all the results, so others in the field could know as soon as possible. Other scientists were designing similar studies, with HIV patients who had bone marrow transplants, based on the earlier Boston findings.
“We felt it would be scientifically unfair to not let people know how things are going, especially for potential patients,” Henrich said….