Adults 'cured' after HIV baby

Following the apparent cure of the HIV baby (see previous post) reports suggest that therapy similar to that of the baby works on adults too. 70 people that were treated with three antiretroviral drugs (ARVs) a lot earlier than people are normally treated: 35 days-10 weeks after infection. The majority relapsed after their treatment was halted, but 14 of them, 10 out of that being male, were able to stay off the ARVs without relapsing like the others. These 14 still have HIV traces in their blood but only levels that their immune system can keep at bay.
This is not total eradication of the virus, but it does enable them to live a a substantial amount of time without drugs (no ARVs etc). It has been made clear tat early treatment is very important- however, this rapid treatment doesn't work for everyone (56 of the 70 relapsed). The 14 adults were also confirmed not to be 'super controllers' (population, 1%, of people with a natural resistance to HIV)- and researchers are now attempting to identify why it only works on some people, which may expand the future for further functional cures.
The senior advisor on HIV/AIDS strategy at the WHO (World Health Organisation) says 'The big challenge is identifying people early in their infection' and also pointing out that the stigma and potential discrimination means that people are reluctant to have a test for it.

Other researchers are working on a way to eradicate HIV from the body completely- by using drugs that  'flushes out' dormant HIV out of its hiding places in the host. This was supported by the trebled levels of dormant HIV in the blood following taking the drug (vorinostat) as this shows that the virus is being removed from cells. And now, an attempt to find a way to kill the HIV which would now be in the blood after use of drugs flushing it out- and so getting rid of the virus from the body completely. Theoretically, HIV can be 'moped up' if it is released form the plasma in cells (if HIV is unlocked from resisting CD4 memory T-cells).

Vorinostat is histone deacetylase (HDAC)  inhibitor- used for treatment of cutaneous lymphoma (brand name- Zolinza). HDAC is an enzyme that contributes to maintaining latency of the genetic material, that is integrated in human cells, of HIV. The idea is to break this HIV latency, thus 'turning on' the HIV genes and the virus to replicate. Vironostat shows the ability to cause mutations (mutangenisis, AMES positive)), which could potentially leads to cancer- although, there were no such events in the study into the drug. This study is hoped to chow that HDAC drugs can be effective and that other less toxic (not AMES positive) can be used to move the 'cure' forward.

Electronic Cigarettes- The Debate

Throughout our lives we are told about the effects of smoking, how bad it is to hour health including increased cancer risk, and yet many still do it. Upon reading my NewScientist, I was drawn to one particular article on electronic cigarettes  I have a particular interest in such due to family members using them on-and-off in a desperate attempt to quit for good. However, are they really any help, or just a menace? Some people think that the wide use of e-cigarettes could save many lives, the number of people using them in the UK is thought to reach a million this year (Acting on Smoking and Health, charity, claimed 700 000 people were using them last year); but some people believe that they are doing harm in normalizing smoking.

These 'cigarettes' vaporise solution (including propylene glycol and vegetable glycerine) into aerosol mist, which simulates the act of smoking. They contain nicotine, just like normal cigarettes- which might be around the same amount of a normal one, but the quantity of nicotine can be chosen by the user, with some opting for none at all. The huge attraction for smokers the these devices is that they look and feel just like the real thing- unlike nicotine patches or gum. They are, however, more pleasant for non-smokers around the people using the e-cigarettes as opposed to real ones; they do not produce toxic gas or smell. A 2012 study showed that carcinogens were typically 1000 higher in smoke from standard cigarettes compared to the vapour from electronic ones.
There is uncertainty around the effects of inhaling of nicotine vapour into the lungs; but there are no combustion products to be inhaled, so no tobacco toxins inhaled which could cause lung disease and cancer.

Are e-cigarettes medicines, or simply a form of cigarette to be on general sale? There is a great disparity when it comes to the view of this across countries, for example in Canada and Australia they are not on shop shelves and people can only buy them on-line for their personal use; whereas, in the US e-cigarettes are classifies as tobacco products so they can be sold legally as consumer products. In the next few months, UK regulators could 'provide a model for which way to go'- the MHRA (Medicines and Healthcare products Regulatory Agency) proposed regulating them as medicines- but would allow them to be continued in retail sale, so that smokers who have already turned to them do not go back to smoking.

Smoking is the world's second biggest avoidable killer (following high blood pressure)- killing 6 million a year. 35% of smokers try to quit each year in the UK, but only around 5% succeed unaided. From a study of of 300 smokers for evidence for whether e-cigarettes help people stop smoking, 9 % quit and a further 20-25% cut intake of real cigarettes by at least half. But how safe are these e-cigarettes? The WHO in 2008 warned that the safety of e-cigarettes had yet to be established.
Action on Smoking and Health (a UK anti-smoking charity) said the use of electronic cigarettes was a 'harm reduction' approach. But they can legally be sold to children, and there are few advertising restrictions- could they be seen as glamorising smoking? They are not regulated medicines like patches or gum, so there are no rules about the purity of nicotine in them. Should the smoking of e-cigarettes be allowed in a public place? The BMA has called for a ban for their use in public places, so there is smaller risk of normalising something that looks like smoking.

How will the regulation change? We can only wait and see...

Speaking for Charity

A short while ago, I was invited to speak at the Bexley Women’s Aid annual conference, and accepted without hesitation. After preparing and presenting a 10 minute talk about the charity’s work in schools and its impact- to a hall of officials- I received useful, supportive and encouraging feedback. The coordinator was so pleased with my work that she contacted my head teacher and I received the Head Teacher’s Award for representing the school in an outstanding way. 

I kept in contact with the women working for the charity, and was invited for a meeting to discuss the possibility of volunteering at one of their refuges. I hope to start soon, on a weekly basis to hopefully gain some valuable experience and help BWA offer their support.

School Medical Club

I have been running a thriving club for aspiring medics for approximately two years. 
There was a small medical club in place, which I attended throughout my GCSE years. As soon as I entered the sixth form, I set out with the aid of certain teachers to reform the group. I aimed for a place where anyone can come to learn and discuss scientific news and breakthroughs and issues relating to medicine and medical ethics, all of which would aid applying for university. I have also managed to use my resources to secure medical students and graduates to join the club to speak to us about their experiences and advice. The club is running and successful to date.

I am now aiming to expand the club, get the lower school interested and passionate about medicine- as well as encouraging peers to come along.

HIV Cure?

Watching BBC news this morning, when admittedly I should have been on my way to school, I was fascinated by the story of a HIV baby in the US being 'cured' by use of very early treatment with drug therapy. This fitted in all too perfectly with my Biology As at the moment, learning about the transmission, global spread, effect and prevention of HIV/AIDS.

What is HIV?

HIV stands for Human Immunodeficiency Virus. The virus enters the body- in this case, across the placenta or during childbirth- and may remain inactive (this is known as being HIV-positive). AIDS is the disease caused by the HIV virus; once the virus is active it attacks and destroys T helper cells in the immune system- these cells normally help to prevent infection. If destroyed, you will be unable to defend yourself against any pathogen that enters your body and you may  contract a range of opportunistic infections. It is the effect of these diseases which eventually kill a person with HIV. AIDS stands for Acquired Immune Deficiency Syndrome. 

It can also be transmitted by: exchange of bodily fluids, unprotected sex, use of unsterilised surgical equipment, sharing needles etc.

HIV/AIDS is a worldwide disease, and is still spreading in pandemic proportions. The majority of people living with it are living in sub-Saharan Africa. 

Latest case

The child in question is now 2 1/2 years old, now off of medication for over a year without infection. Dr Deborah Persaud presented her findings at a conference for retroviruses and opportunistic infections, she said 'This is a proof of concept that HIV can be potentially curable in infants'.

The first person believed to be recovered from HIV, Timothy Ray Brown had his infection eradicated with leukaemia treatment and stem cell transplant from a donor with a genetic mutation that resists HIV- very rare. On the contrary, this case involved a mix of drugs (antiviral therapy) already used to treat infant HIV. 

This suggests that the quick treatment meant that the virus did not have chance to form hideouts in the body. HIV specialist Dr Hannah Gay put the baby on a cocktail of 3 standard HIV fighting drugs at  30 hours old- before the lab tests came back from confirming infection (high risk of the baby to have HIV as the mother recently found out she was carrying the virus and had no treatment). The treatment continued for 18 months, then the child disappeared from the system and 5 months later it was a surprise to find the virus had not returned.

Does this mean a cure?

In the above case, there are very special circumstances: the HIV battled hard and fast just after birth. This worked, meaning that the infant can grow up without having to worry about the implications of HIV- however, the same approach could not be applied to adult cases, with people finding oiut they have the virus a long time (months, years) after acquiring HIV. 

High risk groups in the UK are offered regular testing for the virus, free- however, 25% of people with HIV are unaware of it. This gap in acquiring and finding out that HIV has been acquired gives time for the virus to hide away in the immune system, so no therapy can touch it. 

This approach is definitely not going to provide a cure for the majority affected by the virus. Antiretroviral therapies in the 90s had a great impact on the number of deaths- HIV is not the great killer it once was. But the hunt for a 'cure' is still on.

Opening my latest NewScientist magazine, I was immediately drawn to its covering of the HIV case. Beside stating the majority of things I could learn via the news, this went into more depth of the sceptical response and future for this kind of treatment.
Mario Stevenson said 'At present, this can best be described as a functional rather than a sterilising cure' although also says that every baby of HIV positive mothers should receive 'triple-drug treatments'.Other beliefs, of Davis Margolis, are that the baby could have been a 'super-controller'- this means that the baby had a natural resistance to the virus, due to a fault in the gene that manufactures CCR5 receptors on white blood cells. HIV needs to attach to these receptors to successfully invade cells, meaning super-controllers are protected from infection from this nasty virus. This same mutation was involved in the only other 'cure' case for HIV- Timothy Ray Brown, mentioned above; the stem cells involved in his treatment were from the bone marrow from a super-controller.
Now, therapies are being developed that focus on these CCR5 receptors. Another hope for treatment is vorinostat- a drug that can 'flush out' HIV from its hiding places in cells and ARVs (antiretroviral drugs) can then be used to keep the virus at bay. Several countries are now giving ARVs to all HIV positive mothers rather than only with a CD4 (type of white blood cell) cell count has fallen below a certain amount as a result of the infection.