Fifty years of HIV: how close are we to a cure? | Sunday Observer

Fifty years of HIV: how close are we to a cure?

AIDS awareness campaigners. Pic: Piyal Adhikary/EPA-EFE
AIDS awareness campaigners. Pic: Piyal Adhikary/EPA-EFE

It’s half a century since the first known HIV-related death and two patients appear to have been cured of the virus. What does this mean for the 37 million still living with it?

Nobody knew what killed Robert Rayford. The African American boy was just 15 years old when he presented at St Louis city hospital in late 1968, but the medical team drew a blank.

Unexplained swelling in Rayford’s genitalia soon spread throughout his body. Chlamydia bacteria, usually localised at the point of entry, coursed through his bloodstream. A small purple lesion on the inside of his thigh signalled cancer, but of a form usually found in elderly Ashkenazi Jews and Italians, not teenage black boys who had never left Missouri.

The teenager hardly spoke during the 18 months in which he received treatment at three separate hospitals. “He was the typical 15-year-old who is not going to talk to adults, especially when I’m white and he’s black,” one of his doctors would tell the St Louis Post-Dispatch almost two decades later. He told them he had sex with a girl from his neighbourhood, but gave little else away.

Tragically, pneumonia ended Rayford’s young life during the night of 15 May 1969, but his body had been compromised some time before. Illnesses that a healthy body would ordinarily expunge met with no resistance. Rayford’s clinicians, puzzled by his decline, persuaded his family to submit his body to an autopsy and preserved samples for inspection at a later date.

Twelve years later, in 1981, reports surfaced of young men dying from aggressive forms of pneumonia. Many reported the same purple-black lesion found on Rayford’s inner thigh. Most were “active homosexuals” and, like Rayford, many had immune systems so dysfunctional that a common cold could hospitalise them. The disease was AIDS. There was no effective treatment, let alone a cure.

In the mid-1980s, a young retrovirologist based at Tulane University in New Orleans tested the samples taken from Rayford’s body. They “contained antibodies to every one of the nine HIV proteins used in the test,” reported the Chicago Tribune in 1987. Rayford’s mother, Constance, had little to add when TV cameras showed up on her doorstep: “He was nothing but 16 years old,” she said, bewildered and visibly upset by her child’s posthumous notoriety.

The findings placed the arrival of AIDS in the US more than a decade earlier than popular theories suspected, and afforded Rayford a dubious place in the history of a retrovirus that has since killed more than 35 million people worldwide.

In the US, AIDS would bore its way through society’s faultlines, decimating communities of drug users, sex workers, gay and bisexual men, along with African Americans, and wiping out a generation of creative lodestars, including photographer Peter Hujar, artist David Wojnarowicz, dance pioneer Willi Ninja and Hollywood star Rock Hudson. But the bulk of the deaths occurred in sub-Saharan Africa, where fragile health systems, religious opposition to contraceptive provision and stigma helped the virus spread like wildfire, killing millions and crippling fragile economies ill-equipped to combat a pandemic.

Now, 50 years on from Rayford’s death, news of the second patient seemingly cured of HIV has raised great hopes. Modern antiretroviral treatment can already suppress HIV to the point that it has no impact on life expectancy, and even make it untransmittable. Yet the “London patient”, who has been free of HIV for 21 months and counting, offers something more: the hope of freedom from a virus that 37 million people worldwide are living with.

The human body can fight off most viruses. But HIV infects and eventually wipes out the very cells needed to kill it: CD4 T, coordinators of the body’s immune response. When the virus invades CD4 T cells, it hijacks their internal machinery and begins making thousands of copies of itself, which are shed like spores into the bloodstream. More cells get infected, and the cycle repeats. The body, in an attempt to contain the virus, kills infected cells. “Once the CD4 T cells are wiped out, you have no rudder for your immune system,” says Dr Carl Dieffenbach, director of the Division of AIDS at the US National Institute of Allergy and Infectious Diseases.

Antiretroviral therapy has saved millions of lives by stopping the virus from replicating and allowing the CD4 T cells to recover, keeping the immune system intact. But it cannot eradicate the virus from the body. That’s because when HIV enters its host cell, it sometimes does something highly unusual: it integrates its DNA into that of the cell. At that point, it turns latent, seeding itself in hiding places throughout the body, where it remains inactive and undetectable, immune to antiretrovirals, but creating a reservoir from which it can rebound into full-blown infection without warning. “All you need is one intact virus, somewhere in the body in a CD4 cell, and at some point it’s going to wake up and spread,” says Dieffenbach.