HIV Cure needed like yesterday

Dr Cissy Kityo

By Catherine Murombedzi

AN informative virtual science cafe on HIV Cure Research took place on Friday, with the Health Communicators Forum (HCF) of Zimbabwe capacitated by a Ugandan researcher, Dr Cissy Kityo.

The HCF is hosted by the Humanitarian Information Facilitation Centre, (HIFC) with science cafes supported by Avac.
Dr Cissy has been in the HIV research field since 1990.

She has participated in treatment findings and remains committed to being part of the Cure journey.
While many dismiss a cure as far fetched, to science, everyday is a learning curve, an inch towards HIV Cure.

Dr Cissy simplified science for the HCF inorder for the health science journalists to be able to disseminate correct information.

She talked of a house under construction, it needs a plan.
The building follows the laid out plan. So do our bodies, everyone has a DNA, which is what makes the functions of the body.

Our bodies follow a sequence too, a genetic order.

As a researcher undertaking gene therapy, she talked of the two main therapies under their research project.

“The two types of gene therapy under trial are ex-vivo and in-vivo.
In the ex-vivo gene therapy, target cells are removed from the patient’s body, genetically modified and put back into the patient’s body.

The corrected cells are then re-infused into the patient,” explained Dr Cissy, in the interactive virtual meeting.

“The other intervention is the in-vivo, which has successfully been used in the treatment of blood diseases, specifically blood cancer.

“This is done inside the patient’s body through an injection which will genetically modify in the body.
The target cell may be T cells which then grow resistant to HIV.

The cell grows extensions, thereby replicating to replace the damaged cells. The patient is monitored and with this success, gene therapy is set to be the front runner as it will require no donor.

The patient’s genes are the ones genetically modified,” said Dr Cissy.

DONOR CELLS

To date, only 5 cancer patients have been cured of HIV using stem cell transplant.

The stem cells were all donated. Finding matching donors also takes time and the procedure is very expensive, requiring state-of-the-art hospital settings and expertise.

With 38 million people living with HIV globally, it is impossible to find matching donors. So gene therapy mimics what happened to the 5 patients.
The gene therapy mimics the stem cell treatment.

A similar method in cancer treatment, where a patient is given chemotherapy is used in stem cell, which takes root in virgin bone marrow, the cells start to mutate similar cells which are HIV resistant.

The beauty of HIV gene therapy is that no donor will be required.

CLINICAL TRIALS
In the 1990, ARVs were on clinical trials, the reality was a mirage. Research did not hesitate, patients took the trials, today, drugs keep improving with better outcomes.

Someone took the trials for HIV treatment, someone has to take the trials for the HIV cure.
Science is informed through a learning curve everyday.

“Gene therapy can be done as Ex-vivo, outside the body, genetically modified with no need for a donor. The cells are taken from the patient so no challenges of matching, no fear of rejection of the cells because they belong to the patient. When modified, the cells are planted back into the bone marrow,” said Dr Cissy who took questions to clarify any misunderstanding.

“Then with in-vivo, an injection is given, this is the goal, we are not yet there, we will get there one day. Currently, we are working on ex-vivo. The two procedures, ex-vivo and in-vivo require no donor,” added Dr Cissy.

COST

The gene therapy clinical trials have all taken place in United States and Europe due to the high cost.

Southern Africa, which suffers the burden of HIV is not able to finance the procedure. The tools, the reagents require state-of-the-art handling which Africa lacks. The US Federal government spent US$2,6b on HIV Cure Research. This is slightly more than half of Zimbabwe’s national budget

In Uganda, starting point is effective tools. The World Health Organisation, (WHO) released guidelines on gene therapy three months ago.

BENEFITS
With gene therapy pipeline booming, where a donor was required for stem cell transplant, research studies show that no donor will be required for HIV gene therapy, the patient’s genes will be used in the procedure.

While ARVs manage symptoms, suppressing the HIV virus, gene therapy will be a Cure. An injection will be given 2 months apart with some being two jabs a year with monitoring.

Gene therapy is handy as a possible cure for HIV.

People living with HIV, (PLWHIV) will be able to live without taking drugs because their cells have been restored. Gene therapy becomes a functional HIV Cure.

A report from MoHCC ending June 2022 reports:

First line = 1 160 597
Second line = 49 944
Third line = 499
Total 1 211 030.

The number of defaulting clients keeps growing. With third line costing around US$150 a month per client, treatment adherence is greatly needed.

FUNDING

With the Global Fund (GF), calling for ending Aids by 2030, this means that HIV treatment will be generalised. Anyone infected will be treated like any patient seeking services for a headache or diarrhoea.

With 1.23 people living with HIV in Zimbabwe, if funds and facilities permitted, finding willing participants to a Cure would not be a challenge.

PERSONAL

As a journalist living openly with HIV, I have a new lease of life. My sincere gratitude to science and all who took part in the clinical trials.

Regimens keep improving, today, a single triple combination pill suppresses the virus. A decade ago, these were three separate tablets.

Viral suppression has led to normality, however, the pill burden remains.
“Someone took the HIV treatment clinical trials for the restoration of my health. I am happy to participate in the Cure journey as a participant and journalist.”

HIV Cure, a reality in my living years.
Currently less than 15 % of patients in ART programmes in Africa are on second-line ritonavir-boosted protease inhibitor (PI) regimens, but this proportion will increase significantly over time. Recent studies have shown that most patients failing second-line ART in resource-limited settings do not have major PI resistance-associated mutations. This means that failure is due to poor adherence rather than the development of resistance.

However, with more patients failing on second-line ART regimens for longer durations this will likely change. The threat of “untreatable” multi-drug resistant HIV after second-line failure in Africa is a cause of concern.