Journal Club Review: Is HIV cured or not? – the next decade of AIDS in America

March’s journal club was led by Marie Fiori (Graduate Student in Chemistry). Journal club review was written by Amanda Hurley (Postdoc in Plant Pathology).

On March 4, 2019, the news hit the world that the second case of HIV had been “cured.” Later that month, CaSP convened to discuss the claim and assess the state of HIV control in America. The good news is, indeed, the individual from the article has no detectable HIV particles in his blood; he is technically cured. But calling it “a cure,” suggesting the procedure is robust treatment for HIV infection, is incorrect.

HIV (human immunodeficiency virus) targets and destroys CD4 T cells, which are immune cells that boost response of killer T cells and antibody production. Without CD4 T cells, the immune system is compromised; it can’t activate CD8 T cells, losing effective protection against viruses and cancer, and it can’t switch antibody class, so the antibodies produced have crappy binding affinities. The ingenious strategy of HIV is to take out the very system designed to kill it, leading to the development of acquired immunodeficiency syndrome (AIDS).

The only procedure to reduce viral load in HIV patients without medication involves a bone marrow transplant from a donor with a truncated (Delta32) CCR5 receptor. CCR5 is a chemokine receptor on T cells that HIV binds to in order to enter the cell. The delta32 CCR5 mutant produces a shorter receptor that HIV cannot bind. While this procedure can fail, it’s worked exactly three times in patients nicknamed for their cities – Berlin (2007), London, and, most recently, Dusseldorf (both March 2019). Bone marrow transplants are dangerous and complicated, and the patients received them as last ditch treatments for cancer. As “cures” they are flashy, garnering media attention, but nothing is as effective as a solid public health campaign to treat and prevent HIV infection.

The political and racial history of HIV is more storied than any contemporary illness, and continues to influence policy and public perception today. First known as the “gay plague,” since it primarily infected homosexual men, President Reagan famously refused to mention the epidemic in public until 1985. But what is maybe less well-known is that the original Morbidity and Mortality Weekly Report (MMWR) article in 1981 on a mysterious collection of pneumocystis pneumonia cases in “healthy” men only included white patients; the two cases involving black men were never reported. The racial disparity in HIV awareness and treatment persists to this day. Did you know that half of all gay black men in America will be diagnosed with HIV? This is astounding because the rate in gay white men is 9%. Similarly, the rates of HIV infection differ geographically, intensifying as you travel south and to more rural communities.  

All of these statistics (hopefully) will inform the new initiative – Ending the HIV Epidemic: A Plan for America. The plan, which was released in February 2019 by Alex Azar, the secretary of Health and Human Services, aims to reduce new infections by 90% in 10 years. Strategies include increasing investment in existing programs and identifying high-risk hotspots to provide funds for a local HIV task force. Since current prevention efforts account for only 3% of the current federal funding for HIV, this new initiative should have plenty of room to make a difference.  

To succeed, the plan must recognize that this is an intersectional problem. Intersectionality provides a framework for looking at how social categorizations (race, sexual orientation, gender, sex, ability, etc.) are interconnected and mediate differential treatment from institutions– i.e. combating HIV is a gay issue and it’s a black issue, and only by considering these aspects can the HHS plan work. So what steps can a local HIV task forces take to reduce infection? And more specifically, how can we help gay and bi black men? The only strategy CaSPers could think of is through the education system. Gay children often do not have gay parents (or close role models) to shepherd them through potential risks, especially if they have not yet revealed their sexuality. The HHS plan could train sexual education teachers or provide mentors in the public school system to help keep homosexual adolescent children safe. Based on the current statistics, minority homosexual men lack the resources needed to protect themselves from HIV. We truly hope Azar’s plan reaches out and provides much needed awareness, testing, and treatment for a this historically underserved group of Americans.

CaSP is very interested in highlighting how science disproportionately affects different populations. This topic will be the focus of the 2019 National Science Policy Network Symposium we’re hosting in Madison this November. Come join us to learn more!