“Curing” HIV? Focus must remain on prevention

Young adults

As a physician caring for patients with HIV/AIDS for 25 years, I certainly hope for a cure for this disease that has taken more than 30 million lives since 1981, including 600,000 in the United States. While I am encouraged by recent studies on potential cures, our focus must remain on what is already working: HIV/AIDS prevention, and full access to education and testing.

A closer look at the research

A paper published last fall in a research journal (Clinical Microbiology and Infection) by two French scientists raises the possibility of a cure for HIV/AIDS. This “study” actually includes just two patients -- a 57-year-old man who has been infected with HIV since 1985 and a 23-year-old who was diagnosed in 2011. In both cases, these patients are able to control their infection and stay well without the need for antiviral medications. The reason is thought likely due to a specific genetic mutation unique to these individuals, although the actual mechanism as to why they remain healthy remains unproven.

Discussion of an HIV cure has been taking place for the past few years, initially sparked by the “Berlin Patient” who I will discuss below. In reality, only about 1 percent of all persons infected with HIV are able to stay healthy without the need for antiviral medications. We have several of these patients, known as “elite HIV controllers,” in our clinical program at Lancaster General Health Physicians Comprehensive Care. They have been the subject of intense research for many years. In reality, none are actually “cured” because evidence of HIV can be found in tissue samples from their bodies – but not in their blood. In addition, their immune systems appear to not be damaged by the virus.

Only one true cure

A true “sterilizing” HIV cure would mean there is NO evidence of virus in a person’s body. The only true cure to date has been in Timothy Brown also known as the “Berlin Patient.” Brown underwent two bone marrow transplants as part of his treatment for leukemia from 2006-2007 while living in Germany. Following chemotherapy, radiation, and the bone marrow transplants, he has no evidence of HIV in his body, despite extensive blood and tissues testing. Unfortunately, similar attempts using bone marrow transplants to cure other patients with HIV have failed, including most recently two in Boston.

There also has been hope for many years that quickly and aggressively treating persons soon after infection with HIV would allow them to be cured, or at least control the virus without need for HIV drugs. Most attempts with this approach have failed as well. One child in Mississippi who was thought to be cured after treatment with medications at birth unfortunately showed evidence of infection at the age of 4. She is doing well but now back on antiviral therapy. There are a few isolated cases of persons treated early in the course of infection who have been able to stop medication and are staying healthy but they are not cured. It is important to note that these are rare situations, and if most people on HIV drugs stop treatment, they will develop AIDS-related infections or cancers and eventually die.

Focus on prevention

As exciting as it is to discuss a cure for HIV/AIDS, we must not lose sight of the fact that HIV infection is preventable. HIV prevention starts with testing and identifying those who have already been infected so they can be treated with medications. This not only keeps them healthy, but also decreases their risk of infecting someone else by 95 percent. LG Health offers free HIV testing at our clinic at 554 North Duke Street (3rd floor), Lancaster.

Staying HIV-negative

Prevention interventions such as the use of condoms and education on safe sex practices remain the key to staying HIV-negative. Recent data from the CDC (released Nov. 6, 2014) actually showed a 10 percent decrease in new HIV diagnosis from 2008 to 2012 – the first true decline in new infections since HIV has been a reportable in all 50 states.

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Jeffrey T. Kirchner, DO, FAAFP

Jeffrey T. Kirchner, DO, FAAFP, AAHIVS, is the medical director of Lancaster General Health Physicians Comprehensive Care, and provides HIV/AIDS medical care and education to patients, families, healthcare providers, and the community.

Education: A graduate of Philadelphia College of Osteopathic Medicine, Dr. Kirchner is board-certified in family medicine and as an HIV specialist by the American Academy of HIV Medicine.

Call: 717-544-4943

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