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EPIDEMICS
HIV cure hopes dashed for two US cancer patients
by Staff Writers
Washington (AFP) Dec 06, 2013


Mandela: AIDS campaigners mourn death of a champion
Paris (AFP) Dec 06, 2013 - AIDS campaigners on Friday mourned the passing of Nelson Mandela, declaring his stand against taboo and stigma had turned the tide against the killer disease.

"Nelson Mandela was a central figure in the AIDS movement. He was instrumental in laying the foundations of the modern AIDS response," said Michel Sidibe, head of the Joint UN Programme on HIV/AIDS, or UNAIDS.

"His actions helped save millions of lives and transformed health in Africa. He broke the conspiracy of silence and gave hope that all people should live with dignity."

Of Mandela's achievements, UNAIDS pointed to his decision in 2005 to go public with the news that his own son, Makgatho, had died of AIDS-related causes.

"His public revelation helped drive debate about HIV. And his support to people living with HIV helped to break down stigma and discrimination," UNAIDS said in a press release.

The Global Fund to Fight AIDS, Tuberculosis and Malaria paid tribute to Mandela's "special role" as a breaker of taboo.

"While other political leaders denied or ignored the spread of HIV, causing severe damage by hindering the implementation of effective treatment, Mandela spoke openly," it said.

The International AIDS Society (IAS), whose conferences have spearheaded the war on AIDS and the human immunodeficiency virus (HIV) that causes it, said the world "has lost an extraordinary statesman and human being".

"Mr. Mandela had the power to change hearts and minds, change policies and above all change the public's perception of the virus in the most affected region of sub-Sahara," said Bertrand Audoin, executive director of the IAS.

Failure to address the AIDS crisis in his country has been singled out as a weak spot in Mandela's record as the first president of post-apartheid South Africa, from 1994-1999.

But after he left office, stung by awareness of the problem, he threw himself into combatting discrimination and ramping up access to life-saving drugs through his 46664 Foundation, say activists.

Francoise Barre-Sinoussi, the Nobel-winning French scientist who co-discovered HIV, recalled Mandela's speech to the International AIDS Conference in 2000, which alerted the meeting to the tragedy unfolding in sub-Saharan Africa.

"He said, 'This is the one event where every word uttered, every gesture made, has to be measured against the effect it can and will have on the lives of millions'," she said.

"As a direct result of his speech, mother-to-child transmission in the region almost immediately became a priority and so did access to antiretrovirals.

"I have no doubt that his words that day did indeed save the lives of so many people and continues to do so."

South Africa's Treatment Action Campaign (TAC), which demanded that Mandela's successor, Thabo Mbeki, start distributing antiretrovirals to HIV-infected people, recalled when Mandela in 2002 donned a white T-shirt with the words "HIV Positive".

"In that moment he became one of us and made a powerful statement against stigma, at the same time sending a message to the then denialist government that people living with HIV are part of this country and should be given lifesaving treatment," TAC said.

The latest hopes of curing AIDS were dashed Friday when US researchers said HIV returned in two men who briefly eradicated the virus after bone marrow transplants for cancer.

Experts described the discovery as a "disappointment," but said it offers important new clues in the hunt for the human immunodeficiency virus's elusive hiding places in the body.

Only one person is believed to have been cured of HIV. American Timothy Brown, who suffered from leukemia, received a bone marrow transplant from a rare donor who was resistant to HIV, and has shown no sign of the virus for six years.

"The return of detectable levels of HIV in our patients is disappointing, but scientifically significant," said Timothy Heinrich, a physician-researcher in the Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

"Through this research we have discovered the HIV reservoir is deeper and more persistent than previously known," he said in a statement sent to AFP.

Heinrich first shared the news with fellow researchers at an international AIDS conference in Miami, Florida on Thursday.

Both HIV-positive men received bone marrow transplants as treatment for a kind of blood cancer known as Hodgkin's lymphoma, one in 2008 and the other in 2010.

About eight months after their operations, HIV was no longer detectable.

The patients stayed on antiretroviral therapy even after their HIV was undetectable, and eventually decided to cease taking the drugs earlier this year.

In July, doctors announced early, encouraging results: one patient appeared to still be HIV-free after being off the drugs for seven weeks and the other for 15 weeks.

But signs of HIV soon returned. They were found in the first patient 12 weeks after stopping therapy, and in the second patient after 32 weeks.

"Both patients have resumed therapy and are currently doing well," Heinrich said, adding that the patients do not wish to be identified in the media.

He said it was important to share the results with fellow researchers, because they signal "that there may be an important long-lived HIV reservoir outside the blood compartment."

"We have demonstrated HIV can be reduced to undetectable levels by very sensitive research assays, and the virus persists," he said.

Prior to the viral rebound, one of the patients had only about 1,000 cells in his body left with traces of HIV, and the other had just 100, according to the Foundation for AIDS Research, amfAR, which funded the study.

"These two cases are telling us some information that we weren't otherwise going to be able to learn," said Rowena Johnston, director of research at amfAR.

"As much as it is disappointing for the patients themselves, it is absolutely helping us to learn more about what it is going to take to cure HIV."

Unlike Brown, these patients' bone marrow transplants did not come from donors that carried a genetic resistance to HIV by lacking a CCR5 receptor, so they were not afforded protection against the virus by that mutation.

The two men received transplants from donors with the CCR5 receptor, which acts as a gateway allowing HIV to penetrate the cells.

Researchers had hoped that by continuing to treat the men with antiretroviral drugs during the transplant process and afterward, the medicine might have prevented the donor cells from becoming infected while a new immune system was established.

Instead, it appears the virus may have been lurking undetected in their bodies, infecting the men as if for the first time once repressive drug therapy was stopped.

Still, Myron Cohen, an expert on HIV/AIDS at the University of North Carolina at Chapel Hill, said it was too early to draw conclusions.

"I think we need more information," he told AFP in an email.

"The reason(s) for suppressed growth of HIV in these patients is still being studied, so recurrence -- if it occurred -- needs to be seen as part of a continuum," he said.

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