Progress in HIV/AIDS cure: N.Y. woman is free of HIV for 4 years

Progress in HIV/AIDS cure: N.Y. woman is free of HIV for 4 years

Transcript¹

NPR's Leila Fadel speaks with leading HIV/AIDS researcher Dr. Carlos del Rio about near and far-term impacts of a potential cure for the disease.

LEILA FADEL, HOST:

A New York City woman has been cured of HIV. Her doctors at Weill Cornell Medicine and NewYork-Presbyterian Hospital made the announcement last week. We need to be careful - this is not the first time a cure has been announced. In at least two other instances, the patient relapsed. But the woman, whose identity has not been revealed, has been free of infection for four years. And that success is seen as a step forward in the search for a cure to HIV/AIDS. For some perspective on this, we've called on Dr. Carlos del Rio, a prominent global health expert and HIV/AIDS researcher at Emory University in Atlanta. Welcome.

CARLOS DEL RIO: Good talking to you, Leila.

FADEL: So you've been studying this, working on this for decades. What's your reaction to this news when you heard somebody who's been cured?

DEL RIO: Well, I think it's very exciting. And I think what excites me the most is the science, right? The field of cure research really took off after Timothy Brown, the individual known as the Berlin patient, was shown to be cured from HIV by having a bone marrow² transplant after he had a disease called acute myeloid leukemia.

FADEL: Yeah.

DEL RIO: And since then, we've seen incredible progress in trying to find a cure for HIV.

FADEL: And he did not relapse.

DEL RIO: Correct. You know, Timothy Brown, actually - he died, but he died of recurrence³ of his leukemia, not of recurrence of his HIV.

FADEL: So in this case, is there anything different about this particular case in New York City that might qualify it as a breakthrough?

DEL RIO: Well, what's very unique in this case is the type of transplant was done by people at Cornell. I mean, what happens here is that we know there's a specific mutation⁴ where the virus attaches to cell that if you have that mutation, you're resistant⁵ to HIV. And this is a genetic⁶ abnormality that largely occurs in people of Northern European descent. And it's pretty rare. Only about 1% of people have this. It is not seen in African Americans. It is not seen in Hispanics.

And this woman - you know, people have commented she has a mixed race, meaning she was not just white. She probably was a combination of white and something else. So she had multiple races, but they didn't say she was a white woman. That's a very big difference from the other cures that have occurred. Again, I want to make the point that these are very rare phenomena⁷, these are very rare cures. We have, you know, 37 million living with HIV globally. This is not a scalable intervention⁸. So this is very fascinating science, very cool science that will advance the field of HIV research. But this is also a very rare phenomenon.

FADEL: So to put it into context, because we are hearing the word cure, it doesn't mean that millions of people can be cured of HIV somehow.

DEL RIO: This simply means that, you know, again, all these persons had very severe diseases. This woman also had AML, a very severe disease, a lethal⁹ disease. Had she not received a bone marrow transplant, which is the cure for her leukemia, then she would have died of leukemia. So again, you don't do a bone marrow transplant on somebody who has stable HIV who's taking their medicines because the risk of the bone marrow transplant far outweighs¹⁰ the risk of HIV.

FADEL: So it's significant, then, that a mixed-race woman has been cured because so many people impacted by HIV/AIDS are not white.

DEL RIO: That's correct. And I don't like the term mixed race, but I think it's trying to tell us something. And when we think about it, it's trying to tell us that this is not limited to only, you know, white individuals, that we actually can do this in individuals that are of other races. And we have to remember that in the U.S., about 40% of people living with HIV are African American.

FADEL: So it would be significant that it's not just a cure for one particular race, that it can be something that goes beyond white people.

DEL RIO: Absolutely. That, to me, I think, is one of the most really exciting things. And again, talks about the importance of equity¹¹ and making sure that things we're advancing just don't advance one race or ethnicity and not another.

FADEL: But it does feel like if you think about the way people discussed HIV/AIDS only a few decades ago, they talked about it like a death sentence. And it feels like it's so different today to hear the word cure, to hear so many people living active lives who have HIV.

DEL RIO: Oh, I think the advances on HIV have been tremendous. The fact that, you know - as you're absolutely right, used to be a death sentence. Nowadays, with effective antiretroviral therapy, you can get somebody with HIV to live essentially¹² a normal life. But not only that - we know that people with HIV who receive antiretroviral therapy and have the virus suppressed don't transmit to others. The advances in HIV have really turned this disease around, but we're still trying to find - sort of the two holy grails now are finding a vaccine¹³ and finding a cure.

FADEL: Now, you talked about how - the focus on antiviral medication that allows for a normal life for a lot of people. And there's initiatives like PEPFAR, the U.S. program that is aimed at providing resources and prevention in Central and Western Africa. Is that - I mean, is that the right approach, or should there be more focus on a cure?

DEL RIO: You know, there are two different streams. I think the getting people on therapy continues to be a priority. But there also has to be a Priority, as I said, expanding access to what we call Prep, the preexposure prophylaxis. We haven't done such a good job globally to do that. And that would also decrease the number of new infections. You know, the goal is to decrease the number of new infections globally to under 500,000. We're not there. And we could certainly be there if we expanded a treatment and we expanded prevention. But at the same time, we have to do the science to get us to cure and to get us to vaccine because at the end of the day, that's what we want, right? The ultimate - as I said, the holy grail of HIV research is finding a cure and finding a vaccine.

FADEL: What are some other approaches when you think about getting to that 500,000 number or lower that should be at the forefront of the global fight against HIV and AIDS.

DEL RIO: Well, what's clearly at the forefront of that is improving our ability to improve what we call the HIV care continuum. In other words, diagnose people shortly after they're infected, linking them to care, getting them in therapy and keeping them on antiretroviral therapy and suppressed for the rest of their lives. So when they go on, they age. And they age - they go into healthy aging. And then they go on to die with HIV but not of HIV. But the other thing we need to do is to also identify the people who are at high risk of developing HIV, of acquiring HIV and getting them on preexposure prophylaxis before they develop HIV because if we did that, we will all of a sudden be able to curb¹⁴ the epidemic¹⁵.

FADEL: Dr. Carlos del Rio of Emory University in Atlanta. He's the co-director of the Emory Center for AIDS Research. Thank you so much.

DEL RIO: Happy to be with you.

(SOUNDBITE OF HYPERNATURAL'S "CHANGING TIDES")

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 marrow   

n.骨髓；精华；活力

参考例句：

• It was so cold that he felt frozen to the marrow. 天气太冷了，他感到寒冷刺骨。
• He was tired to the marrow of his bones.他真是累得筋疲力尽了。

3 recurrence   

n.复发，反复，重现

参考例句：

• More care in the future will prevent recurrence of the mistake.将来的小心可防止错误的重现。
• He was aware of the possibility of a recurrence of his illness.他知道他的病有可能复发。

4 mutation   

n.变化，变异，转变

参考例句：

• People who have this mutation need less sleep than others.有这种突变的人需要的睡眠比其他人少。
• So far the discussion has centered entirely around mutation in the strict sense.到目前为止，严格来讲，讨论完全集中于围绕突变问题上。

5 resistant   

adj.(to)抵抗的，有抵抗力的

参考例句：

• Many pests are resistant to the insecticide.许多害虫对这种杀虫剂有抵抗力。
• They imposed their government by force on the resistant population.他们以武力把自己的统治强加在持反抗态度的人民头上。

6 genetic   

adj.遗传的，遗传学的

参考例句：

• It's very difficult to treat genetic diseases.遗传性疾病治疗起来很困难。
• Each daughter cell can receive a full complement of the genetic information.每个子细胞可以收到遗传信息的一个完全补偿物。

7 phenomena   

n.现象

参考例句：

• Ade couldn't relate the phenomena with any theory he knew.艾德无法用他所知道的任何理论来解释这种现象。
• The object of these experiments was to find the connection,if any,between the two phenomena.这些实验的目的就是探索这两种现象之间的联系，如果存在着任何联系的话。

8 intervention   

n.介入，干涉，干预

参考例句：

• The government's intervention in this dispute will not help.政府对这场争论的干预不会起作用。
• Many people felt he would be hostile to the idea of foreign intervention.许多人觉得他会反对外来干预。

9 lethal   

adj.致死的；毁灭性的

参考例句：

• A hammer can be a lethal weapon.铁锤可以是致命的武器。
• She took a lethal amount of poison and died.她服了致命剂量的毒药死了。

10 outweighs   

v.在重量上超过( outweigh的第三人称单数 )；在重要性或价值方面超过

参考例句：

• Her need to save money outweighs her desire to spend it on fun. 她省钱的需要比她花钱娱乐的愿望更重要。 来自《简明英汉词典》
• Its clarity in algebraic and analytical operations far outweighs any drawbacks. 文化代数和解析运算中的清晰性远远胜过任何缺点。 来自辞典例句

11 equity   

n.公正，公平，（无固定利息的）股票

参考例句：

• They shared the work of the house with equity.他们公平地分担家务。
• To capture his equity,Murphy must either sell or refinance.要获得资产净值，墨菲必须出售或者重新融资。

12 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

13 vaccine   

n.牛痘苗，疫苗；adj.牛痘的，疫苗的

参考例句：

• The polio vaccine has saved millions of lives.脊髓灰质炎疫苗挽救了数以百万计的生命。
• She takes a vaccine against influenza every fall.她每年秋季接种流感疫苗。

14 curb   

n.场外证券市场，场外交易；vt.制止，抑制

参考例句：

• I could not curb my anger.我按捺不住我的愤怒。
• You must curb your daughter when you are in church.你在教堂时必须管住你的女儿。

15 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。