By Avit Ndayiziga
It is Monday morning July 22, 2024, in Munich, Germany, at Messe München, a Trade Fair center, and the International Congress Center, a venue that hosts AIDS 2024, the 25th International AIDS Conference organised by the International AIDS Society
This conference gathers scientists, policymakers, healthcare professionals, people living with HIV, funders, media and communities to strengthen policies and programmes that ensure an evidence-based response to HIV and related epidemics.
This year’s conference convenes more than 10,000 participants from around the world. It has a specific theme of “Putting People First.” According to Sharon Lewin, the IAS President and International Co-Chair, putting people first is a viable route to progress by closing the inequality that has been observed in HIV/AIDS responses. “In a world plagued by inequality, putting people first across all aspects of the HIV response is a moral imperative and the only viable route to progress. Whether in the design of clinical trials, the formulation of policies or any other aspect of our efforts, people living with and affected by HIV must be not just beneficiaries but the actors driving our efforts.”She noted.
“I once had HIV” – The story of a cure
Beyond the conference’s theme of putting people first, this 25th International AIDS Conference has kicked off with a promising HIV cure as the world has recorded seven patients who have been cured of HIV following a stem cell transplant.
During a symposium session of the German AIDS Society (DAIG e.V.), the “Düsseldorf Patient” Marc Franke shared his personal story of being cured of HIV.
“In 2008, I received the diagnosis of HIV. However, I didn’t immediately begin antiretroviral therapy (ART) until two years later, in 2010. It was in 2011 that I learnt about my Acute Myeloid Leukemia (AML), and a year later, the disease relapsed. On Valentine’s Day in 2013, I underwent a stem cell transplant, which involved only 2 bags of 250ml. Five years after the transplant, I discontinued my ART. Finally, last year, a heartwarming article in Nature Medicine was published, bringing hope and optimism. Marc Franke ended with a smile, saying that the transplant smells like tomatoes.”
He also added that a huge percentage of HIV in the body lies in the Gut with 60 percent, 33 per cent in the Nymph Nodes and 0.2 percent lies in the blood.
Stem cell transplant paves a path to HIV cure
Aside from Marc Franke, in another study entitled “Next Berlin Patient” presented by Christian Gaebler of Charité – Universitätsmedizin Berlin, another patient had both leukaemia and HIV. However, he received a stem cell transplant for leukaemia in late 2015; then, in late 2018, he stopped taking antiretroviral treatment for HIV. About five-and-a-half years later, he remains in HIV remission.
“A healthy person has many wishes, a sick person only one,” said the next Berlin Patient, who has chosen to remain anonymous.
Any case of sustained HIV remission without antiretroviral treatment is noteworthy. But in most HIV cure cases following stem cell transplants, the donors had naturally inherited two copies of the CCR5-delta32 mutation – one from each parent. Also known as homozygous, these individuals are essentially immune to HIV.
This is the first HIV cure case in which the donor had inherited just one copy of the CCR5-delta32 mutation – known as heterozygous. These individuals can acquire HIV, but the virus generally progresses slowly if they do not receive antiretroviral treatment. Significantly more people have heterozygous mutations than homozygous mutations.
The study concludes that “effective reservoir reductions, durable HIV remission and potential cure can be achieved with functional viral co-receptors, suggesting that allogeneic immunity fundamentally contributes to HIV eradication”.
“The next Berlin Patient’s experience suggests that we can broaden the donor pool for these kinds of cases, although stem cell transplantation is only used in people who have another illness, such as leukaemia. This is also promising for future HIV cure strategies based on gene therapy because it suggests that we don’t have to eliminate every single piece of CCR5 to achieve remission,” Lewin said.
However, according to Winnie Byanyima, Executive Director of UNAIDS, “We don’t have an HIV vaccine or cure yet, but we have the next best thing: a prevention medication that is 100% effective.said Winnie Byanyima, urging Gilead to “make history” by allowing generic manufacturing of Lenacapavir, a twice-yearly injectable antiretroviral medication used to treat HIV patients.
She also urged Gilead to open up Lenacapavir to the UN-backed Medicines Patent Pool international organisation, whereby cheaper generic versions could be sold under license in low- and middle-income nations.
Whatever the financial rewards of creating Lenacapavir, the renown of being the company that conquered the AIDS pandemic would be greater, Byanyima concluded.
Lenacapavir is a novel HIV capsid inhibitor being developed by Gilead Sciences. It is being studied for its potential use in the treatment of HIV infection. Capsid inhibitors like Lenacapavir work by targeting the HIV capsid protein, which is essential for viral replication. This class of drugs shows promise in combating HIV and may offer new treatment options for individuals living with the virus.
The International AIDS Conference is the premier global platform to advance the HIV response. As the world’s largest conference on HIV and AIDS, it sits uniquely at the intersection of science, advocacy and human rights, bringing together scientists, policy makers, healthcare professionals, people living with HIV, funders, media and communities. Since its start in 1985, the conference has served as an opportunity to strengthen policies and programmes that ensure an evidence-based response to HIV and related epidemics.