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HIV-Positive Population Braces for Another Plague
Mysterious deaths and experimental drugs are all too familiar to survivors of the 1980s epidemic.
As the world gritted its teeth and prepared for the worst from COVID-19, a bit of good news flew under the radar earlier this month: A man from London appears to be the second person in the world to be cured of HIV.
Some four decades after the HIV pandemic first began spreading in North America, an experimental stem cell treatment armed a formerly HIV-positive patient with a gene that helps guard against the virus. He has, tentatively, been cured. The news was first announced a year ago but was officially reported in the Lancet HIV with longer-term data on March 10.
It is a risky treatment and has thus far been used only in extraordinary circumstances. But the fact that there are now two cases where the virus has been eliminated, freeing patients from their daily drug cocktail—the first case was recorded in 2008—has provided hope that there may yet be an end to the AIDS crisis.
The announcement should have been cause for celebration, but amid another pandemic, hope has been muted—especially in light of worries among public health officials that immunocompromised people, including those living with HIV and AIDS, could be particularly at risk for complications from COVID-19.
Deborah Birx has spent decades on the front line of the fight against HIV. Since 2014, she has been the United States global AIDS coordinator, and, more recently, she was tapped by Vice President Mike Pence to run point on the White House’s COVID-19 response.
[Mapping the Coronavirus Outbreak: Get daily updates on the pandemic and learn how it’s affecting countries around the world.]
At a press briefing at the White House on Saturday, Birx’s dual responsibilities were obvious.
“I just wanted to conclude with a group of clients and patients that we are all very worried about,” she said. “These are individuals that we call long-term survivors from HIV. They’re here, across the country, [and] have survived more than four decades with HIV. Many of them still carry a level of immunocompromised. To all of them out there, please take care of yourself. Please ensure that you’re doing everything possible to ensure you don’t get exposed.”
So far, the degree of extra risk is largely unknown.
The Conference on Retroviruses and Opportunistic Infections, which focuses heavily on HIV/AIDS and related infectious diseases, was scheduled to begin March 8 in Boston. The event went ahead via teleconference but pivoted heavily toward focusing on the COVID-19 outbreak. While researchers underscored that there continues to be no evidence that people with HIV are at a higher risk of COVID-19, the virus is still ill-understood. The Centers for Disease Control and Prevention is recommending that HIV-positive people have on hand a 30-day supply of their medication, keep their vaccinations up to date, and be prepared in case they do get sick.
Last week, CNN reported that HIV-positive people in China are facing shortages of their medication as harsh lockdown requirements are imposed by Beijing and many fear having their condition revealed; the Wuhan LGBT Centre began working in shifts to deliver the necessary medicine to those who had run out. At least one man was outed by the police as a result.
If there are risks to coinfection, the harm may be particularly acute through parts of Africa with particularly high HIV-positive populations. While there was initially hope that COVID-19, like more common strains of influenza, is largely seasonal, outbreaks in Australia, Brazil, and other warmer countries suggest that weather and temperature have little bearing on the virus. There have been reports of community transmission of COVID-19 in several African countries, including South Africa, Algeria, and Senegal.
“We really have no idea how COVID-19 will behave in Africa,” Glenda Gray, president of the South African Medical Research Council and an HIV researcher, told Science on Sunday.
The similarities between the two viruses go beyond their rapid spread.
Researchers have found that COVID-19 contains a mutation similar to HIV; both target the furin enzyme. An upcoming paper in the journal Antiviral Research suggests that targeting furin makes COVID-19 particularly infectious.
While some have latched on to that information as a sign that COVID-19 was manmade, scientists say it is merely evidence that coronaviruses are evolving to become more efficient.
But COVID-19 and HIV may share more than just genetic traits—they may share treatment strategies as well. A patient in South Korea, who likely contracted the virus in Wuhan, China, was hospitalized with COVID-19 in early February. A week after becoming infected, the patient developed a fever and cough. On Day Eight, doctors administered lopinavir and ritonavir—marketed by the brand name Kaletra—a common part of the antiretroviral cocktail used to treat HIV. The drug showed some promise in treating SARS as well.
A day later, according to a paper submitted to the Journal of Korean Medical Science, the viral load of COVID-19 began to decrease, and the patient recovered.
It’s a promising sign, but it is far from conclusive. “It is possible that the decreased load of SARS-CoV-2 resulted from the natural course of the healing process rather than administration of lopinavir/ritonavir, or both,” the paper stresses. A case study published in The Lancet on a patient who had traveled to Wuhan and tested positive for COVID-19 showed that Kaletra reduced his fever but did not address his symptoms. He died in the hospital.
Other preliminary studies have confirmed that the drug may hold promise, but clinical trials will be needed to fully establish its utility. Australian researchers believe combining Kaletra with Chloroquine, an anti-malaria drug, holds promise to treat the virus.
AbbVie, which manufacturers Kaletra, has promised to provide the drug to health authorities who request it while also safeguarding the supply for HIV-positive patients who rely on it.
The threat of another pandemic is all too familiar to those who lived through the AIDS crisis—not just in terms of the virus’s deadly spread, but also with respect to the government’s reaction.
“For many of us, it’s deja vu all over again,” said Gregg Gonsalves, assistant professor of epidemiology at Yale School of Medicine, on the Rachel Maddow Show last week. “It was death by public policy in the 1980s, where we had malign neglect by the Reagan administration that let tens of thousands of Americans die before the president even uttered the word ‘AIDS.’”
Gonsalves drew a direct link between Reagan and President Donald Trump, who consistently tried to downplay the seriousness of COVID-19. “All these years later, we have another president, again, malevolence and incompetence, put together, to really put in peril many, many more people in the United States and everywhere,” he said.