Progress in HIV/AIDS cure: N.Y. woman is free of HIV for 4 years
Progress in HIV/AIDS cure: N.Y. woman is free of HIV for 4 years
NPR's Leila Fadel speaks with leading HIV/AIDS researcher Dr. Carlos del Rio about near and far-term impacts of a potential cure for the disease.
LEILA FADEL, HOST:
A New York City woman has been cured of HIV. Her doctors at Weill Cornell Medicine and NewYork-Presbyterian Hospital made the announcement last week. We need to be careful - this is not the first time a cure has been announced. In at least two other instances, the patient relapsed. But the woman, whose identity has not been revealed, has been free of infection for four years. And that success is seen as a step forward in the search for a cure to HIV/AIDS. For some perspective on this, we've called on Dr. Carlos del Rio, a prominent global health expert and HIV/AIDS researcher at Emory University in Atlanta. Welcome.
CARLOS DEL RIO: Good talking to you, Leila.
FADEL: So you've been studying this, working on this for decades. What's your reaction to this news when you heard somebody who's been cured?
DEL RIO: Well, I think it's very exciting. And I think what excites me the most is the science, right? The field of cure research really took off after Timothy Brown, the individual known as the Berlin patient, was shown to be cured from HIV by having a bone marrow transplant after he had a disease called acute myeloid leukemia.
DEL RIO: And since then, we've seen incredible progress in trying to find a cure for HIV.
FADEL: And he did not relapse.
DEL RIO: Correct. You know, Timothy Brown, actually - he died, but he died of recurrence of his leukemia, not of recurrence of his HIV.
FADEL: So in this case, is there anything different about this particular case in New York City that might qualify it as a breakthrough?
DEL RIO: Well, what's very unique in this case is the type of transplant was done by people at Cornell. I mean, what happens here is that we know there's a specific mutation where the virus attaches to cell that if you have that mutation, you're resistant to HIV. And this is a genetic abnormality that largely occurs in people of Northern European descent. And it's pretty rare. Only about 1% of people have this. It is not seen in African Americans. It is not seen in Hispanics.
And this woman - you know, people have commented she has a mixed race, meaning she was not just white. She probably was a combination of white and something else. So she had multiple races, but they didn't say she was a white woman. That's a very big difference from the other cures that have occurred. Again, I want to make the point that these are very rare phenomena, these are very rare cures. We have, you know, 37 million living with HIV globally. This is not a scalable intervention. So this is very fascinating science, very cool science that will advance the field of HIV research. But this is also a very rare phenomenon.
FADEL: So to put it into context, because we are hearing the word cure, it doesn't mean that millions of people can be cured of HIV somehow.
DEL RIO: This simply means that, you know, again, all these persons had very severe diseases. This woman also had AML, a very severe disease, a lethal disease. Had she not received a bone marrow transplant, which is the cure for her leukemia, then she would have died of leukemia. So again, you don't do a bone marrow transplant on somebody who has stable HIV who's taking their medicines because the risk of the bone marrow transplant far outweighs the risk of HIV.
FADEL: So it's significant, then, that a mixed-race woman has been cured because so many people impacted by HIV/AIDS are not white.
DEL RIO: That's correct. And I don't like the term mixed race, but I think it's trying to tell us something. And when we think about it, it's trying to tell us that this is not limited to only, you know, white individuals, that we actually can do this in individuals that are of other races. And we have to remember that in the U.S., about 40% of people living with HIV are African American.
FADEL: So it would be significant that it's not just a cure for one particular race, that it can be something that goes beyond white people.
DEL RIO: Absolutely. That, to me, I think, is one of the most really exciting things. And again, talks about the importance of equity and making sure that things we're advancing just don't advance one race or ethnicity and not another.
FADEL: But it does feel like if you think about the way people discussed HIV/AIDS only a few decades ago, they talked about it like a death sentence. And it feels like it's so different today to hear the word cure, to hear so many people living active lives who have HIV.
DEL RIO: Oh, I think the advances on HIV have been tremendous. The fact that, you know - as you're absolutely right, used to be a death sentence. Nowadays, with effective antiretroviral therapy, you can get somebody with HIV to live essentially a normal life. But not only that - we know that people with HIV who receive antiretroviral therapy and have the virus suppressed don't transmit to others. The advances in HIV have really turned this disease around, but we're still trying to find - sort of the two holy grails now are finding a vaccine and finding a cure.
FADEL: Now, you talked about how - the focus on antiviral medication that allows for a normal life for a lot of people. And there's initiatives like PEPFAR, the U.S. program that is aimed at providing resources and prevention in Central and Western Africa. Is that - I mean, is that the right approach, or should there be more focus on a cure?
DEL RIO: You know, there are two different streams. I think the getting people on therapy continues to be a priority. But there also has to be a Priority, as I said, expanding access to what we call Prep, the preexposure prophylaxis. We haven't done such a good job globally to do that. And that would also decrease the number of new infections. You know, the goal is to decrease the number of new infections globally to under 500,000. We're not there. And we could certainly be there if we expanded a treatment and we expanded prevention. But at the same time, we have to do the science to get us to cure and to get us to vaccine because at the end of the day, that's what we want, right? The ultimate - as I said, the holy grail of HIV research is finding a cure and finding a vaccine.
FADEL: What are some other approaches when you think about getting to that 500,000 number or lower that should be at the forefront of the global fight against HIV and AIDS.
DEL RIO: Well, what's clearly at the forefront of that is improving our ability to improve what we call the HIV care continuum. In other words, diagnose people shortly after they're infected, linking them to care, getting them in therapy and keeping them on antiretroviral therapy and suppressed for the rest of their lives. So when they go on, they age. And they age - they go into healthy aging. And then they go on to die with HIV but not of HIV. But the other thing we need to do is to also identify the people who are at high risk of developing HIV, of acquiring HIV and getting them on preexposure prophylaxis before they develop HIV because if we did that, we will all of a sudden be able to curb the epidemic.
FADEL: Dr. Carlos del Rio of Emory University in Atlanta. He's the co-director of the Emory Center for AIDS Research. Thank you so much.
DEL RIO: Happy to be with you.
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