Twenty-five years ago a nurse called me emergently into the hospital room of a “disorderly” patient. As I walked into the room, expecting to find an outraged belligerent man, I instead found a sobbing, naked man huddled on the floor in the fetal position. Written on the wall from the blood dripping out of the lose IV in his arm, were the words, “death with dignity”. I froze in shock. My eyes filled with tears. I covered him in a blanket and put him back to bed. I would never know the fear and pain he was experiencing… and I lived through the eye of this damn epidemic. So, to expect a generation that has never experienced the death of friends, family or lovers, to understand that HIV is still killing hundreds of thousands of people a year, may be unrealistic. To have them give a damn may be impossible. But affecting millions and killing hundreds of thousands a year, it still is.
It is estimated that THIRTY-SEVEN million people in the world are infected with HIV. Three million of those are children. One million of those are in the Unites States. Since the beginning of the epidemic over THIRTY-TWO million people have died. Approximately 700,000 died last year. The HIV epidemic is here and it is not going anywhere anytime soon. But there is good news…the rate of new infections and deaths are definitely slowing down drastically. Here is where we can all make a difference.
I am not sure that there will be a cure for AIDS in my life-time. But I am sure it can be completely contained. At least a quarter of the people infected with HIV don’t know it. Which means that one of the main ways of controlling this epidemic is that all people who are at risk, and indeed perhaps all people, should be tested for HIV. If positive, they should be placed on treatment immediately. Studies now confirm that having an undetectable viral load means that HIV cannot be spread. Undetectable means unstransmitable. Secondly, it you have unprotected sex, you should be on pre- exposure prophylaxis (PrEP). Not just if you’re gay. Everyone. In the U.S.A. one of the highest rates of new infections is among African American women in the south. HIV doesn’t discriminate. The healthcare system does. Until the distribution of healthcare is more equal in this country, remember that protection means prevention.
So, today, ask someone who has lived with HIV or through the epidemic about the “bad old days”. Learn from the past. It is a part of a history that you should know…because it isn’t over. It may be just beyond the horizon, but it is not beyond our memory. Does World AIDS Day really mean anything anymore? It should.
It was reported last week that HIV had returned in two HIV positive men after bone marrow transplants had seemingly wiped the virus out. The men were thought to be cured as there was no trace of the virus for several months after foregoing their antiretroviral drugs. But the virus returned in August for one of the men, November for the other. This setback has been widely seen as a disappointment and a step backward on the road toward an eventual cure, but I strongly disagree.
The word “cure” was again uttered in regards to HIV a couple of years ago in the case of Timothy Brown. Mr. Brown was HIV positive and also had a form of blood cancer. His only treatment was a bone marrow transplant.
It was purely coincidence that Mr. Brown’s bone marrow donor lacked a gene called the delta-32. Without this gene all T cells made from that marrow would lack an essential protein necessary for the HIV virus to invade the T cells. In essence Mr. Brown’s T cells became resistant to HIV infection — something found in only a small percentage of the world population.
The case of the two patients at Brigham’s Women’s hospital in Boston is quite different. These two men were HIV positive and had a blood cancer like Mr. Brown. They had been on successful HIV therapy until the time of their new transplant with bone marrow stem cells. Therefore, there was no evidence of HIV in their blood stream at the time of the transplant.
The difference from Timothy Brown’s case, however, is that the bone marrow donors did NOT have the missing delta-32 gene. The hope was that since there was no HIV in the blood, the new T- cells would not get infected. Alas, they both showed signs of recurrent infection within the year.
What this tells us is that even though HIV can be virtually eradicated from the blood, it is still hiding in very deep reservoirs within the body. These reservoirs could be cells of almost any organ, including the brain.
Obviously research needs to continue in developing medications that can block the CCR5 protein (what the delta-32 gene codes for) or possibly creating stem cell banks of tissue that is deficient in the delta-32 gene.
This is not a step backward. On the contrary, any scientific information propels us forward. We have learned from this. It DOES take us one step closer to a cure for HIV.
Picture 1 – A healthy T cell; attribution: “Healthy Human T Cell” by NIAID is licensed under CC by 2.0
Picture 2- An HIV-infected T cell; attribution: “HIV-infected HP T cell” by NIAID is licensed under CC BY 2.0
