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THE fight against HIV has taken a turn in our favour with news that the virus has all but disappeared in two infected people. Meanwhile, the World Health Organization (WHO) is opening up antiretroviral treatment to millions of infected people who do not currently qualify.
The two men were diagnosed with a blood cancer called Hodgkin鈥檚 lymphoma after they had become HIV-positive. Three to four years ago they received chemotherapy to kill off white blood cells and the cells that produce them, before undergoing a bone marrow transplant to restore their blood systems.
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A few months ago, the men came off antiretroviral drugs because levels of the virus had fallen to undetectable levels in their bodies. They remain apparently free of the virus.
鈥淭he donor cells appear to have been protected from infection during replacement of host cells,鈥� says of Brigham and Women鈥檚 Hospital in Boston, Massachusetts, who discussed the cases at a meeting of the in Kuala Lumpur, Malaysia, this week.
There is one previous case of an HIV-positive individual seemingly being cured following a bone marrow transplant, but the donor was HIV-resistant. Henrich鈥檚 patients received bone marrow from ordinary donors, making their apparent recovery a puzzle.
鈥淲e need to understand better why these patients have undetectable virus,鈥� says Fran莽oise Barr茅-Sinoussi of the Pasteur Institute in Paris, France, who was not involved in the study. Barr茅-Sinoussi, who shared a Nobel prize in 2008 for the co-discovery of HIV as the virus that causes AIDS, says studying the men could lead to new treatments that do not involve transplants.
Another option is simply to treat people with HIV earlier. Until this week, the WHO recommended that HIV treatment should begin when each millilitre of an infected person鈥檚 blood contains fewer than 350 CD4 cells, the white blood cells targeted and destroyed by HIV. At the Malaysia meeting, it launched new guidelines . This would raise the number of people eligible for treatment worldwide from 16.7 million to 26 million.
Philippa Easterbrook, an HIV specialist with the WHO, says the evidence behind the change in policy came from a WHO review of 24 studies, which shows that early treatment lowers the chances of both disease progression and transmission. 鈥淭he evidence base was compelling,鈥� she says.
Earlier treatment appears to prevent spread by flushing the virus from the blood. Within three to six months of starting earlier treatment, 80 per cent of people with HIV have undetectable levels of virus in their blood.
鈥淲e all welcome these new guidelines to treat at the 500-cell cut-off,鈥� says Barr茅-Sinoussi. 鈥淲e must work through national programmes, NGOs and communities in the field to apply these recommendations.鈥�
This article appeared in print under the headline 鈥淒ouble good news from HIV front line鈥�