When 28 Stories for AIDS in Africa inspired me to study medicine, I thought I was brilliant enough to find a cure to HIV. I imagined that state-of-the-art laboratory equipment, combined with the drive of curing my patients, would slip everything into place. I imagined that, like a light bulb, the solution would suddenly be clear. I didn’t want fame and fortune, and I still don’t. I want people to get better.
Soon enough I learned that the solution to HIV/AIDS is less simple than slotting numbers together in a mathematical equation. It’s more complex than the chemistry I devoted my time to both in high school and the beginning of university.
The virus is as intelligent as a technically-dead organism could be. It’s powers of mutation are unrivaled. Its survival mechanisms are cunning. It hides when you are looking for it. It multiplies surreptitiously, destroying the body’s defenses without it realising it. Until it is too late.
Before I understood the virus, I wondered about replacing the entire body’s blood supply in one go – remove all the infected blood at once and replace it with healthy blood. But the virus does not settle simply in the blood. It creates reservoirs in the bone marrow and the spleen. And evidence shows that reservoirs may be established in the kidneys and the brain.
Then the Berlin patient was cured in an unorthodox and dangerous fashion: Leukemia treatment and bone marrow transplant. Although it has revolutionised the field of HIV-research, the results have failed to be duplicated in subsequent patients.
The field is growing and moving. Today I read an article in the Huffinton Post that shows that we are a step closer once more – and once again it is using a cancer treatment. JQ1, an experimental chemoterapeutic drug, is proving an interesting and potentially powerful drug against HIV. Although it hasn’t yet been tested on human subjects, it seems that this drug releases the latent viruses from their reservoir, thus exposing them to destruction by conventional antiretroviral therapy.
Now the question is: how will it fare in human trials? Will the side-effects be as bad as conventional ARVs? Will there be nasty interactions between this drug and ARVs or Tuberculosis drugs? What about psychiatric effects? Renal effects? Will this become a viable and safe treatment? Will we see cures, or just better-managed infections?
What if a patient has a resistant virus? Then it will be of no use that the virus is released from its reservoir, because it won’t be killed by ARVs.
And the big question: Will this drug be accessible to the developing world? Will it be affordable to those patients who live on less than the equivalent of two Dollars a day? Will our governments fund this medication?
I hope so. Deep inside me I can feel a bubble of excitement. Imagine. Just imagine!