This week, another individual may have been cured of HIV after receiving a stem-cell transplant from a donor with a natural resistance to the virus, similar to the procedure the "Berlin Patient" went through. Another study finds that long-acting injectable rilpivirine (Edurant) significantly suppresses HIV replication in rectal tissue. And inflammation levels in women do not seem to decrease as much as levels in men after achieving viral suppression, a study suggests. To beat HIV, you have to follow the science!
Second Person Possibly Cured of HIV, Remains on Antiretroviral Therapy
A second person may have been cured of HIV through a stem-cell transplant, but remains on antiretroviral therapy, the European AIDS Treatment Group reported at the HIV Drug Therapy meeting in Glasgow, United Kingdom.
This person lives in Dusseldorf, Germany. Similar to Timothy Ray Brown, the first person cured of HIV, the Dusseldorf patient was diagnosed with HIV and a few months later with acute myeloid leukemia (AML). He was also treated with an allogeneic stem cell transplant, as well as further therapy for two relapses of AML.
The stem cells came from a donor who has a mutation of the CCR5 coreceptor, making them naturally resistant to the most common strain of HIV. All samples collected from the Dusseldorf patient since that early 2013 transplant show no proviral DNA and his viral load has remained undetectable. His medical team is planning further assays before deciding whether to suspend HIV treatment. Test results so far, however, "suggest that HIV may have been eradicated," the team says.
Related: This Week in HIV Research: HIV-Related Inflammation May Be Irreversible
Long-Acting Rilpivirine Suppresses HIV in Rectal but Not Cervical or Vaginal Tissue
In a small phase-1 study, long-acting injectable rilpivirine significantly suppressed HIV replication in rectal but not in cervical or vaginal tissue, The Lancet HIV reported.
Two-thirds of the 36 HIV-negative study participants were women. It is unclear whether these results mean that rilpivirine will not be effective in preventing HIV acquisition in women, study authors said. The highest concentrations of the study drug occurred nine days after injection, with drug levels sufficient to suppress HIV replication in rectal tissue lasting up to 112 days after administration of rilpivirine. Some of the drug persisted in the tissue up to 56 more days. This could cause drug resistance, if a person using this form of pre-exposure prophylaxis (PrEP) acquired HIV during those two months.
Despite reports of mild to moderate injection site pain, all study participants said they would use this form of HIV prevention. That level of acceptance is based on receiving only one injection rather than the recurring shots that would be needed in clinical practice, study authors cautioned.
Women's Inflammation Levels Higher Than Men's After Viral Suppression
Women's levels of inflammation do not decline as much as men's after achieving viral suppression, a clinical trial published in Journal of Acquired Immune Deficiency Syndromes found.
Eight markers of inflammation and immune activation were measured in 215 participants in the ACTG A5175 trial. On average, women had lower viral loads at baseline and their CD4 counts increased more over 48 weeks of antiretroviral treatment compared to men. However, their levels of interferon γ and tumor necrosis factor α were also higher at week 48 than were those of the men in the study.
In addition, while men's interferon γ levels decreased over the course of the trial, women's increased. Similarly, women had less soluble CD14 (sCD14) at baseline, but after an increase of this marker between weeks 24 and 48, ended with higher sCD14 levels than men. The greater immune activation shown by this data may explain why women's progression to death equals that of men, even though women start out with lower viral loads, study authors noted.