New research on a 59-year old member of a very rare group of HIV+ patients referred to as “elite controllers” has revealed exciting new evidence that could guide scientists towards the development of a cure for the devastating virus.
The immune system of an elite controller is naturally better at combatting the HIV virus which means they can often go much longer without treatment. However members of this group, which represents approximately 0.3% of HIV sufferers, will eventually need medical treatment to prevent the progression to AIDS.
The study, led by UCL, the University of Oxford and the University of North Carolina at Chapel Hill, involved a man who suffered from both HIV and myeloma, a cancer of the bone marrow.
The bone marrow produces white blood cells, including those that help to control HIV. To treat the patient’s myeloma, his bone marrow was completely removed and replaced using his own stem cells. When the bone marrow was removed, the immune system was severely impaired, allowing the HIV to re-activate, replicate and multiply.
When the patient’s immune function returned about two weeks after the transplant, the levels of HIV in his bloodstream rapidly fell. His immune system reduced HIV levels at a similar rate to the most powerful treatments available, bringing them back down from 28,000 to 50 copies per ml within six weeks.
“By measuring the strength of the immune system required to keep this virus under control in this rare individual, we have a better idea of the requirements for successful future treatment,” says co-author Professor Deenan Pillay (UCL Infection & Immunity). “We also managed to identify the specific immune cells that fought the infection. This is a single patient study, but nevertheless it is often the unusual patients who help us to understand the HIV disease process.”
The results of the study revealed that the mechanisms associated with this particular patient’s immune system had enabled him to handle large bursts of HIV activity and so it should be possible to cure the deadly virus with a ‘kick and kill’ strategy.
“Kick and kill” involves stimulating the immune system with a vaccine, then re-awakening dormant HIV strands hiding in white blood cells with a chemical ‘kick’ so that the boosted immune system would then locate and kill them. Basically flushing out the HIV virus so that white blood cells can destroy any remaining strands.
Until now it was unclear whether the human immune system would be able to control HIV following full-blown reactivation of the virus. However this insightful new research, published in Clinical Infectious Diseases, demonstrates that this has been possible in a single patient case study.
Dr Ravi Gupta (UCL Infection & Immunity) said: ‘The immune system can be as powerful as the most potent drug cocktails. This study takes us one step closer by showing us what type of immune responses an effective vaccine should induce.’
His colleague Professor Deenan Pillay, said: ‘By measuring the strength of the immune system required to keep this virus under control in this rare individual we have a better idea of the requirements for successful treatment.’
Dr Gupta that although the results looked ‘promising’, they would be unlikely to lead to a cure for at least a decade.
Although current antiretroviral treatments can suppress HIV and delay the onset of Aids for many years it cannot rid the body of the virus completely. Check out some of the more recent statistics regarding UK and Ireland HIV infection rates below:
United Kingdom and Ireland HIV statistics
Northern Ireland HIV statistics: Source (2013)
- Northern Ireland had the largest proportional increase in new HIV diagnoses between 2000 and 2013 compared to the rest of the UK
- 94 new first-UK cases of HIV were diagnosed in Northern Ireland, a rate of 7.8 per 100,000 population aged 15–59 years (14.1 per 100,000 males and 1.6 per 100,000 females)
- Of the new diagnoses of HIV in Northern Ireland in 2013, 57% occurred in men who have sex with men (MSM).
- 749 HIV-infected residents of Northern Ireland received care for their HIV during 2013
- Of those receiving care, 54% (408/749) acquired their infection through sexual contact involving MSM and 42% (312/749) acquired their infection through heterosexual contact
- 56,339 HIV tests were carried out in Northern Ireland, of which 25,789 were performed as part of the antenatal screening programme
Ireland HIV statistics: Source (2013)
- In 2013, 344 people were newly diagnosed with HIV in Ireland, giving a rate of 7.5 per 100,000 population.
- 258 Males and 86 females
- Average age of new diagnosis was 34.
- The highest proportion of new diagnoses in 2013 (46.2%) were among men who have sex with men (MSM).
- Heterosexual contact accounted for 38.1% of new diagnoses. Among the heterosexual cases, 57% were among individuals originating from countries with generalised epidemics, 8% had a high‐risk partner or a partner known to be HIV positive
- 2% or 18 people of new diagnoses were among Injecting Drug Users (IDUs).
- Three Mother to Child Transmission (MTCT) cases were diagnosed.
- Ireland was reported as the country of birth for 141 new diagnoses (41%) with 174 reportring as not born in Ireland.
- Of the newly diagnoses in 2013 with CD4 count available (88%), 50% were reported as late presenters (CD4 count of <350 cells/mm3), compared with 48% in 2012 and 52% in 2011. The proportion of those diagnosed late varied by risk group and was highest among heterosexuals (59%) and PWID (56%). 25% of people were severely immuno-compromised at diagnosis. 27 cases (8%) were diagnosed with an AIDS defining illness at the time of their HIV diagnosis.
UK HIV statistics:: Source (2012)
- 6,360 new HIV diagnoses
- The two groups most affected remain gay and bisexual men and black African heterosexuals – three-quarters of people diagnosed with HIV in 2012 were among these two groups
- 3,250 new HIV diagnoses among men who have sex with men — the highest number ever recorded in a year
- 2,880 new HIV diagnoses were acquired heterosexually and over half of them probably acquired their infection in the UK
- Just under half of adults were diagnosed with HIV at a late stage of infection (after the point at which treatment should have begun)
- The number of people living with HIV in the UK has doubled in the last 10 years
- Around 100,000 people are living with HIV in the UK
- One in five people with HIV in the UK are undiagnosed
- About two thirds of people living with HIV are men and a third are women
- Over half of all people living with HIV are aged between 30 and 49, but there are significant numbers both of young people and older people now living with HIV