Prof. Ravi Gupta is a Professor of Clinical Microbiology and a Wellcome Trust Senior Fellow. In March this year he presented a ground breaking research on a potential cure for HIV using stem cell transplantation.
He was among researchers at the University College London (UCL) that treated the HIV positive man referred to as ‘London Patient’ who remained in HIV remission off antiretroviral therapy (ART), 19 months after receiving a bone marrow transplant from a CCR5 negative donor for Hodgkin’s lymphoma.
Gupta who visited Nigeria, recently, discussed the treatment and hope of cure for HIV among others in this interview, at the sidelines of a seminar for health reporters on current HIV/TB issues organised by the Institute of Human Virology, Nigeria (IHVN) in Abuja. Excerpts.
Can you briefly tell us how you and the other researchers were able to achieve remission in the ‘London Patient’ using stem cell transplant?
We were able to demonstrate remission on the second case till date through a similar approach to the Berlin patient. (The Berlin Patient is Timothy Brown, who has remained free of HIV and off ART since a bone marrow transplant 12 years ago and, until now, was the only adult considered to be cured of HIV).
But there were some important differences. We had a HIV positive individual who also had cancer, Hodgkin’s lymphoma. He required a transplant because the chemotherapy for his cancer was not successful.
So the last option for this patient was to have a stem cell transplant and fortunately in Europe we were able to find a donor who matched the patient. We were also able to find a donor who had a deletion in the CCR5 protein and this was again similar to what had been achieved on the Berlin patient, and of course the CCR5 protein is critical for virus entry so that the virus cannot survive without it. The procedure was very technical and it was very aggressive. It was complicated but it looks successful so far. What challenges did you encounter during the procedure? The challenges were of course the transplant itself, which had its own problems, but those were managed by the transplant doctors, the cancer doctors. From the HIV point of view, the challenges were measuring the amount of virus in the body which is very difficult when the levels are very low. Patients who are on ART have very low levels any way. When you give chemotherapy, they go even very lower because you destroy a lot of cells so measurements have been challenging but we are using the best test we can. This has been a huge team effort. We have been working with other people around Europe, for example, and we have collaborated across the United Kingdom as well. We’ve taken advantage of good collaborations that exist to help with cure efforts, so measurement was difficult and then ethics, getting ethics was not too difficult but deciding when to stop treatment was the next one. Would you say you have a cure for HIV now? We have managed to induce a very good remission in one person but it’s not the answer for everyone. It is not the cure. It is a cure. We have probably achieved a cure but not the cure. “The” is the one that you can give to everybody. Why is the remission in the London patient not being simply referred to as a cure for HIV? It probably is a cure but we just want to be careful with the language because, first of all, it’s hard to prove a cure. You can’t prove it very easily so cancer doctors use the term remission all the time. So if you’re in remission for cancer, you are very happy because you can say you are cancer free. In the same way, if you are in remission for HIV, you are HIV free. You don’t need HIV drugs. As time goes on, we could probably think about using the word, cure, more because if it is not coming back then it has probably gone away. The person was just lucky to have one? Is that very fortunate. Everyone else who has HIV has antiretroviral. ARVs are much better than they used to be. What is the hope for HIV cure in the nearest future? This case has given a lot of encouragement to researchers in different areas, in different countries to really go for it now because they have seen that it’s been done twice so there is a lot of momentum. We can see public support behind it. The science is going to be pushed quite forward. What is your take on treating co-infections such as people having HIV and TB, high blood pressure or other diseases? There have historically been drug interactions or drug incompatibility problems between chemotherapy and anti-retroviral but nowadays there are no interactions between chemo therapies and anti-retroviral for the ones we use so that is fortunate. We can change drugs around to avoid problem. So we are able to manage that problem. Secondly, things like blood pressure tablets and diabetes; we can manage those issues in most cases. Can HIV positive patients donate organs to other people? There was a recent report of a HIV positive patient donating a healthy kidney to another person. Could there be complications? The kidney transplant was from a HIV positive person to another HIV positive person. They were both HIV infected so the problem has been usually, HIV positive people can’t donate organs but this is a nice example where somebody with HIV could actually donate an organ because they have a tissue match and are compatible. That was a nice success story to show that HIV was not a barrier to donating organs.
Credit: Daily Trust