Stem Cell Transplant: Miracle Cure Against HIV

In News

• A U.S. patient with leukemia (blood cancer) has become the first woman and the third person to date to be cured of HIV after receiving a stem cell transplant from a donor who was naturally resistant to the virus that causes AIDS.

About

• Only two people have reportedly been cured of HIV so far and both have relied on bone marrow transplants from donors who carried the mutation, called CCR5 delta 32 that naturally makes one immune to an HIV infection and AIDS.
• The previous transplants involved adult stem cells and these cells from the bone marrow replaced their immune system.

What are Stem Cells?

• Stem cells are undifferentiated, or “blank,” cells. This means they’re capable of developing into cells that serve numerous functions in different parts of the body.
  • They can divide over and over again to produce new cells.
  • As they divide, they can change into the other types of cell that make up the body.
• Cancer and cancer treatment can damage the hematopoietic stem cells. Hematopoietic stem cells are stem cells that turn into blood cells.

Types of Stem Cells

• Stem cells are divided into 2 main forms. They are embryonic stem cells and adult stem cells.
• Embryonic stem cells: The embryonic stem cells used in research today come from unused embryos. These result from an in vitro fertilization procedure. They are donated to science. These embryonic stem cells are pluripotent. This means that they can turn into more than one type of cell.
• Adult stem cells: There are 2 types of adult stem cells. 
  • One type comes from fully developed tissues such as the brain, skin, and bone marrow. There are only small numbers of stem cells in these tissues. They are more likely to generate only certain types of cells. For example, a stem cell that comes from the liver will only make more liver cells.
  • The second type is induced pluripotent stem cells. These are adult stem cells that have been changed in a lab to be more like embryonic stem cells. Induced pluripotent stem cells don’t seem to be different from embryonic stem cells, but scientists have not yet found one that can develop every kind of cell and tissue.

Stem Cell Transplant

• A bone marrow transplant is a medical treatment that replaces one’s bone marrow with healthy cells. The replacement cells can either come from the person’s own body or from a donor.
• A bone marrow transplant is also called a stem cell transplant or, more specifically, a hematopoietic stem cell transplant.

Is this a reliable method?

• While this approach is certainly a welcome addition to the arsenal of treatments, stem cell therapy is a cumbersome exercise and barely accessible to most HIV patients in the world.
• This method requires stem cells from that rare group of individuals with the beneficial mutation.
• Antiretroviral therapy has now ensured that HIV/AIDS isn’t always a death sentence and many with access to proper treatment have lifespan comparable to those without HIV.
• A vaccine for HIV or a drug that eliminates the virus is still elusive and would be the long sought ‘cure’ for HIV/AIDS.

Acquired immunodeficiency syndrome (AIDS) 

• About:
  • It is a chronic, potentially life-threatening health condition caused by the human immunodeficiency virus (HIV) which damages the human immune system.
• Transmission: 
  • Through direct contact with certain body fluids (blood, semen, rectal fluid, vaginal fluid or breast milk) from a person infected with HIV.
• Symptoms:
  • Stage 1: Flu-like illness (Fever, chills, rashes, night sweats)
  • Stage 2: Clinical latency (No particular symptoms)
  • Stage 3: AIDS (Weakening of Immune System)
• Prevention & Treatment: 
  • Prevention is better than cure, using protective techniques, non-contaminated needles & preventing mother to child transmission.
  • Effective antiretroviral treatment (ART) prevents HIV transmission from mother to child during pregnancy, delivery and breastfeeding. 
  • HIV is treated with antiretroviral therapy consisting of one or more medicines.
  • ART does not cure HIV but reduces its replication in the blood, thereby reducing the viral load to an undetectable level.
  • ART enables people living with HIV to lead healthy, productive lives. It also works as an effective prevention, reducing the risk of onward transmission by 96%.
  • ART should be taken every day throughout the person’s life. People can continue with safe and effective ART if they adhere to their treatment.
  •  In cases when ART becomes ineffective due to reasons such as lost contact with health care providers and drug stock outs, people will need to switch to other medicines to protect their health.
  • Someone who is on antiretroviral therapy and virally suppressed will not pass HIV to their sexual partners.
  • Condoms prevent HIV and other sexually transmitted infections, and prophylaxis use antiretroviral medicines to prevent HIV. 
• HIV Facts & Figures: 
  • AIDS Society of India, India has the third-highest HIV burden with 2.35 million.
  • In 2019, there were 69,220 new HIV infections and 58,960 AIDS-related deaths in India. 
  • UNAIDS Report 2020, Asia Pacific region saw a 12% decline in new HIV infections and a 29% decline in AIDS-related deaths over the last decade.

Prevalence of HIV/AIDS in India

• Declining trend: As per the India HIV Estimation 2019 report, the estimated adult (15 to 49 years) HIV prevalence trend has been declining in India since the epidemic’s peak in the year 2000 and has been stabilizing in recent years.
  • In 2019, HIV prevalence among adult males (15–49 years) was estimated at 0.24% and among adult females at 0.20% of the population.
• State wise data: Maharashtra had the maximum at 3.96 lakh followed by Andhra Pradesh (3.14 lakh) and Karnataka.

Steps taken by Government of India

• National AIDS Control Programme (NACP) (Central Sector Scheme) 
• India has achieved the 6th Millennium Development Goal (MDG 6) of halting and reversing the HIV epidemic.
• Prevention from Parent to Child Transmission (PPTCT) programme
• HIV/AIDS Act 2017 (prohibits discrimination or unfair treatment of HIV-infected people on any grounds)
• PALS (PPTCT ART Linkages Software) System (Repository of HIV positive pregnant women)
• 90:90:90 strategy as adopted by UNAIDS (90% (diagnosed, treatment (by anti-retroviral treatment (ART)) & suppression)) by 2020.
  • Extended by 10 years with the goal post of 95-95-95.
• Social Awareness through workshops.
• Viral Load Testing Facilities: They  have been scaled up, and HIV counseling, testing and community-based screening for early diagnosis have been ramped up to achieve the target of Elimination of Mother to Child Transmission of HIV. 

• Project Sunrise: It was launched by the Ministry of Health and Family Welfare (2016) to tackle the rising HIV prevalence in north-eastern states. 

Challenges

• Removing Social Stigma, human rights violations, social exclusion
• Inequalities that drive AIDS.
• Shortage of medicines for HIV like lopinavir/ritonavir. 
• Dearth of financial resources.

Way Ahead

• India’s National Aids Control Organization says that ART is freely available to all those who require it and there are deputed centers across the country where they can be availed from.
• Action against inequalities to end AIDS by 2030, 
• Centre and States coordination, 
• Involvement of NGOs & enhance budget allocation.

Source: TH