For more than 30 frustrating years, doctors have struggled to find a cure for HIV. Now, with the help of stem cell research, they’re closer than ever before.
“This approach has the potential to provide lifelong immunity to HIV,” Dr. Scott Kitchen, an associate professor of hematology and oncology at UCLA’s David Geffen School of Medicine, told The Daily Beast. A UCLA AIDS Institute faculty member, Kitchen’s research centers on immune system abnormalities, focusing on the Human Immunodeficiency Virus, or HIV. In more than a dozen published studies, Kitchen has researched why immune cells do not destroy AIDS, and clarified why early AIDS/HIV drugs failed. He recently received a $1.7 million grant from California’s Stem Cell Agency to continue his research to HIV.
“The cells effective in combating the virus were entirely stem-cell generated. What is significant is the cells were able to respond,” he said of his recent work. Because stem cells are capable of regenerating and growing new cells repeatedly, Kitchen’s findings show how stem cell-treated immune cells could destroy HIV and continue to destroy any recurring HIV infection—something that has not been seen before.
AIDS/HIV became the world’s leading infectious killer because the human immune system’s T-cells—which can usually slash all kinds of viruses and bacteria—were never strong enough to vanquish HIV. Kitchen is testing stem-cell-generated T-cells that can overpower the HIV virus like never before.
When the battle against AIDS/HIV began three decades ago, stem cell research was in its infancy. Scientists knew little about how to harness its potential, or even whether it might be useful in treating HIV. The first cases of AIDS, or Acquired Immunodeficiency Syndrome, were reported in 1981. A 1982 New England Journal of Medicine article highlighted doctors’ concerns about a mysterious, unknown immune deficiency that had taken the lives of several young gay men. Since then, the World Health Organization estimates about 35 million people have died of HIV infection.
AIDS/HIV is not the death sentence it once was, thanks to daily medications. Antiretroviral drugs, called ARTs or ARVs, are taken by many HIV patients. ARVs slow but cannot halt the progression of infection. According to the U.S. Department of Health and Human Services, ARVs are the reason the annual number of HIV-related deaths has decreased in the U.S. since the 1990s.
Yet, according to National Institutes of Health data, about 95 percent of those living with HIV are in developing countries, where it is still fatal, and where it has orphaned millions of children.
At the start of the epidemic in the 1980s, researchers worldwide began exploring treatments using animal subjects. Back in 2011, Kitchen co-authored “Stem cell-based approaches to treating HIV infection” in the journal Current Opinion in HIV and AIDS. He wrote that stem cell-based strategies for treating HIV were “a novel approach toward reconstituting the ravaged immune system with the ultimate aim of clearing the virus from the body.” Stem cell treatments utilize patients’ own cells for testing on humans, not animals, specifically targeting HIV, which by then had become one of “the dominant strategies under development,” in his view. Kitchen still utilizes some animal-based research, but stem cell advances will make large clinical trials possible, and “have provided the impetus for a renewed and expanded interest in the development of new cell-based strategies to treat HIV infection as well as a variety of other diseases.”
What’s next? Large clinical trials on human patients to demonstrate safety of treatments.
Over many years of experimenting, Kitchen has demonstrated how stem-cell-generated treatments can be recast from laboratory animal experiments into safe tests for human volunteers—which has been problematic throughout the history of HIV research. “A hallmark of our studies is safety,” Kitchen said. “It really shows that modifying of (the human immune system’s) T-cells could be done in a clinical setting.”
Safety has been the paramount factor. The experimental process includes bone and blood procedures, and past experiments have proven to be too strenuous and unsafe for patient volunteers. Some HIV patients suffer from drug side effects, or weakness even when medication allows them to live a somewhat normal life. So volunteering for experimental procedures is arduous — a reality that has left previous results less useful as a predictor too.
Current research worldwide has immense potential, but one thing’s for sure after 30 years: Kitchen’s method has great potential.
Stem cell advances to potentially eradicate HIV are crucial. According the Kaiser Foundation’s analyses of U.S. Funding for HIV/AIDS data, $32 billion was spent during fiscal year 2017, and individual states spend millions. California alone spends about $1.8 billion annually, and ranks second in the nation in cases of HIV, with more than 170,000 cases.
Funding has historically been a challenge— one that a cure would quash. Antiretroviral drugs, or ARVs, are taken daily by many HIV patients. ARV costs are state-supported in some states but not others, which means that pharmaceutical companies offer patient-affordability programs for some ARVs but not others. Because HIV wears down the immune system, some patients are in better health than others based on their geographical location and socioeconomic status and therefore need unequal kinds of drugs. Diverse insurance plans cover some but not all ARVs: Some patient co-pays exceed $600 or even $2,000 per month.
As the U.S. Department of Health and Human Services puts it, “Understanding HIV and ART (antiretroviral therapy) related-costs in the United States is complicated because of the wide variability in medical coverage, accessibility, and expenses across regions, insurance plans, and pharmacies . . . and financial barriers to (patients) filling their prescriptions.”
Stem cell innovation may drive down these complex, high HIV costs. There are currently an estimated 36.7 million people living with HIV worldwide; of those, about 18.2 million take ARVs throughout their lives. Local agencies work to insure patients get the drugs they need so that HIV will not spread, as that costs even more in public health crises.
ARVs suppress the virus, but do not destroy it. According to the Centers for Disease Control and Prevention, there are about 1.1 million people in the U.S. living with HIV, and about 166,000 who do not know they are infected. Making sure that HIV-positive individuals get tested is critical to the public health goal of preventing its spread. About 30 percent of new infections are transmitted by people who do not know they have HIV infection, and that is how it continues to be spread. “It’s bad enough people are dying of AIDS, but no one should die of ignorance,” the late AIDS activist and actress Elizabeth Taylor once said.
“There are a lot of researchers working on developing stem cell therapies for HIV,” CIRM’s McCormack notes. CIRM has invested around $73 million in several HIV projects. “We fund different approaches because at this stage we don’t know which approach will be most effective, and it may turn out that it’s ultimately a combination of these approaches, or others, that works,” McCormack explained.
Living HIV-positive while navigating costs, being HIV-infected and not knowing it, fighting to stop infection in places where it’s fatal, perennial funding of research and treatment—closure for all of this would be welcome.