STDs: Causes, Symptoms and Treatments
Man Appears Free Of HIV After Stem Cell Transplant
A 42-year-old HIV patient with leukemia appears to have no detectable HIV in his blood and no symptoms after a stem cell transplant from a donor carrying a gene mutation that confers natural resistance to the virus that causes AIDS, according to a report published Wednesday in the New England Journal of Medicine.
The patient underwent a stem cell transplant and since, has not tested positive for HIV in his blood.
"The patient is fine," said Dr. Gero Hutter of Charite Universitatsmedizin Berlin in Germany. "Today, two years after his transplantation, he is still without any signs of HIV disease and without antiretroviral medication."
The case was first reported in November, and the new report is the first official publication of the case in a medical journal. Hutter and a team of medical professionals performed the stem cell transplant on the patient, an American living in Germany, to treat the man's leukemia, not the HIV itself.
However, the team deliberately chose a compatible donor who has a naturally occurring gene mutation that confers resistance to HIV. The mutation cripples a receptor known as CCR5, which is normally found on the surface of T cells, the type of immune system cells attacked by HIV.
The mutation is known as CCR5 delta32 and is found in 1 percent to 3 percent of white populations of European descent.
HIV uses the CCR5 as a co-receptor (in addition to CD4 receptors) to latch on to and ultimately destroy immune system cells. Since the virus can't gain a foothold on cells that lack CCR5, people who have the mutation have natural protection. (There are other, less common HIV strains that use different co-receptors.)
People who inherit one copy of CCR5 delta32 take longer to get sick or develop AIDS if infected with HIV. People with two copies (one from each parent) may not become infected at all. The stem cell donor had two copies.
While promising, the treatment is unlikely to help the vast majority of people infected with HIV, said Dr. Jay Levy, a professor at the University of California San Francisco, who wrote an editorial accompanying the study. A stem cell transplant is too extreme and too dangerous to be used as a routine treatment, he said.
"About a third of the people die [during such transplants], so it's just too much of a risk," Levy said. To perform a stem cell transplant, doctors intentionally destroy a patient's immune system, leaving the patient vulnerable to infection, and then reintroduce a donor's stem cells (which are from either bone marrow or blood) in an effort to establish a new, healthy immune system.
Levy also said it's unlikely that the transplant truly cured the patient in this study. HIV can infect many other types of cells and may be hiding out in the patient's body to resurface at a later time, he said.
"This type of virus can infect macrophages (another type of white blood cell that expresses CCR5) and other cells, like the brain cells, and it could live a lifetime. But if it can't spread, you never see it-- but it's there and it could do some damage," he said. "It's not the kind of approach that you could say, 'I've cured you.' I've eliminated the virus from your body." Health.Com: 10 questions to ask a new partner before having sex
Before undergoing the transplant, the patient was also found to be infected with low levels of a type of HIV known as X4, which does not use the CCR5 receptor to infect cells. So it would seem that this virus would still be able to grow and damage immune cells in his body. However, following the transplant, signs of leukemia and HIV were absent.
"There is no really conclusive explanation why we didn't observe any rebound of HIV," Hutter said. "This finding is very surprising."
Hutter noted that one year ago, the patient had a relapse of leukemia and a second transplant from the same donor. The patient experienced complications from the procedure, including temporary liver problems and kidney failure, but they were not unusual and may occur in HIV-negative patients, he said.
Researchers including Hutter agree that the technique should not be used to treat HIV alone. "Some people may say, 'I want to do it,'" said Levy. A more logical -- and potentially safer -- approach would be to develop some type of CCR5-disabling gene therapy or treatment that could be directly injected into the body, said Levy.
Less invasive options to alter CCR5 could be on the horizon within the next five years, said Levy. "It's definitely the wave of the future," he said. "As we continue to follow this one patient, we will learn a lot."
One drug that's currently on the market that blocks CCR5 is called maraviroc (Selzentry). It was first approved in 2007 and is used in combination with other antiretroviral drugs. Health.Com: Who's most at risk for STDs?
In 2007, an estimated 2 million people died from AIDS, and 2.7 million people contracted HIV. More than 15 million women are infected worldwide. HIV/AIDS can be transmitted through sexual intercourse, sharing needles, pregnancy, breast-feeding, and/or blood transfusions with an infected person. Health.Com:What should I do if the condom breaks?
"For HIV patients, this report is an important flicker of hope that antiretroviral therapy like HAART [highly active antiretroviral therapy] is not the endpoint of medical research," Hutter said.
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All About Leukemia • HIV and AIDS • The New England Journal of Medicine • Stem Cell Research
Having A Baby When You Are Living With HIV
Key pointsPeople living with HIV can give birth to HIV-negative babies. Most of the advice for people with HIV is the same as it would be for anyone else thinking about having a baby. Some extra steps are necessary though to reduce the likelihood of HIV being passed on.
This page takes you through the things to consider when having a baby in the UK. From conception to infant feeding, it is important to keep your healthcare team informed so that you can receive specific advice that will work for you.
When a person is taking HIV treatment, and they have an undetectable viral load, the risk of HIV being passed on to their baby is just 0.1% (or one in a thousand). Between 2015 and 2016 in the UK, only 0.3% of people with HIV (including people with a higher viral load) passed on HIV to their baby.
When thinking about conceiving, the advice will depend on each individual's circumstances. Advice will be based on your general health; whether you are taking anti-HIV drugs; your viral load; and whether your partner has HIV.
If you are not already taking anti-HIV medication, you will be advised to do so. HIV can be passed on during pregnancy and birth; having an undetectable viral load will prevent this.
If you are planning on getting pregnant and are already taking anti-HIV medication, talking to your healthcare team will give you a clearer understanding about your current medication and if it is still the best option during pregnancy. In the UK, if your current anti-HIV medication is effective you will likely be advised to keep on taking it.
How can we conceive if one of us is HIV negative and one is living with HIV?When a person living with HIV has an undetectable viral load, there is no risk of HIV transmission during sex. Providing the partner living with HIV has an undetectable viral load and neither of you have any sexually transmitted infections (STIs), sex without a condom is fine.
If you or your partner have a detectable viral load, it is important to discuss conception options that reduce or remove risk of transmission during sex to you/your partner and baby. Before deciding not to use condoms, get advice from your HIV healthcare team so that they can confirm what would work best for you. This may include the HIV-negative partner taking PrEP. PrEP reduces HIV transmission and is safe to take during pregnancy and breastfeeding.
Everyone planning a pregnancy – whether or not they have HIV – is advised to take a daily folic acid supplement whilst trying to conceive and for the first 12 weeks of pregnancy. Folic acid (vitamin B9) helps cells in the body to develop. It is difficult to get enough through diet alone.
HIV treatment during pregnancyAll pregnant people living with HIV are advised to start taking medication by week 24 of pregnancy, if they are not already. This is because an undetectable viral load prevents transmission during conception, pregnancy and birth.
Your birth planSasha Goodman talks about having children as a woman living with HIV.
If you have an undetectable viral load at week 36 of pregnancy, the options for delivery are the same as anyone who does not have HIV. If there are no other considerations, then having a vaginal birth is an option for you. You will be advised to give birth in a facility that can provide the right tests and treatment for your child.
If your viral load is high (over 1000 copies), your doctor will likely recommend a planned caesarean delivery. A caesarean section (also known as a C-section) is an operation to deliver a baby that involves making a cut in a person's stomach and womb. This prevents contact with blood and other fluids that a baby may come into contact with during a vaginal birth. A caesarean reduces the risk of passing on HIV.
Regardless of their viral load though, a person with HIV may have a caesarean for other medical reasons.
Medication for your babyYour baby will need to take anti-HIV drugs for a period of time after birth. This will be in liquid form. This does not mean that your baby has HIV.
Glossary undetectable viral loadA level of viral load that is too low to be picked up by the particular viral load test being used or below an agreed threshold (such as 50 copies/ml or 200 copies/ml). An undetectable viral load is the first goal of antiretroviral therapy.
viral loadMeasurement of the amount of virus in a blood sample, reported as number of HIV RNA copies per milliliter of blood plasma. Viral load is an important indicator of HIV progression and of how well treatment is working.
caesarean sectionMethod of birth where the child is delivered through a cut made in the womb.
effectivenessHow well something works (in real life conditions). See also 'efficacy'.
pre-exposure prophylaxis (PrEP)Antiretroviral drugs used by a person who does not have HIV to be taken before possible exposure to HIV in order to reduce the risk of acquiring HIV infection. PrEP may either be taken daily or according to an 'event based' or 'on demand' regimen.
The length of time your baby will need to take medication will depend on your viral load. If you are undetectable throughout pregnancy, your baby will be giving medication for two weeks. If you are detectable, this may be extended to four weeks.
In the early years of your baby's life, HIV tests will be done several times: just after birth; at six weeks; at 12 weeks; and at 18 months (final HIV antibody test).
If these tests are negative and you have never breastfed, you will know for sure that your baby does not have HIV.
Feeding your babyIn the UK (as with other high resourced countries) it is advised not to breastfeed your baby. The best way to ensure that HIV is not transmitted is to formula feed, as there is no risk of HIV being passed on.
Although HIV is in an important factor to consider, it is not the only one. You may consider breastfeeding for other reasons. If you do consider breastfeeding, it is important that you have an undetectable viral load and stay in regular contact with your healthcare team. Before breastfeeding, it is important to discuss this with them. It is important that you stop breastfeeding if any of the following occur:
This will help to reduce HIV transmission during breastfeeding, but the most effective way to remove all risk is not to breastfeed.
You can read more about infant feeding choices on another page.
From conception, to pregnancy, to delivery, to infant feeding, your journey will be unique to you. It is important that you get the best support and medical care for you and your baby. Staying in touch with your healthcare team will support you in achieving this.
HIV Infection
This diabetes drug may be used as adjunct therapy for treating HIVCurrently, doctors use combinations of antiretroviral drugs to suppress HIV replication. But many patients taking ART treatment show signs of residual viral replication and immune impairment. A new study has indicated that a widely used diabetes drug may be the new weapon against HIV.
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