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Ezra Long
Ezra Long

The Cure

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The Cure


We are pleased to introduce you to this series of regattas dedicated to making life better for women with breast cancer. Our website demonstrates our commitment to you as a resource for rowers, paddlers and friends who wish to make a contribution to the search for cures for breast cancers. Many rowers and paddlers are so dedicated to their sport, that when Breast Cancer touches their lives, the network of friends in the water community is a natural resource for making a difference. Now all water sport participants have a ready-made avenue to make that happen.

We are CURE Epilepsy - the leading nongovernmental agency fully committed to funding research in epilepsy.Our organization was founded by Susan Axelrod and mothers of children with epilepsy who joined forces to spearhead the search for a cure.

HIV entry into CD4+ cells requires interaction with a cellular receptor, generally either CCR5 or CXCR4. We have previously reported the case of an HIV-infected patient in whom viral replication remained absent despite discontinuation of antiretroviral therapy after transplantation with CCR5Δ32/Δ32 stem cells. However, it was expected that the long-lived viral reservoir would lead to HIV rebound and disease progression during the process of immune reconstitution. In the present study, we demonstrate successful reconstitution of CD4+ T cells at the systemic level as well as in the gut mucosal immune system after CCR5Δ32/Δ32 stem cell transplantation, while the patient remains without any sign of HIV infection. This was observed although recovered CD4+ T cells contain a high proportion of activated memory CD4+ T cells, ie, the preferential targets of HIV, and are susceptible to productive infection with CXCR4-tropic HIV. Furthermore, during the process of immune reconstitution, we found evidence for the replacement of long-lived host tissue cells with donor-derived cells, indicating that the size of the viral reservoir has been reduced over time. In conclusion, our results strongly suggest that cure of HIV has been achieved in this patient.

Destruction of the immune system by the HIV is driven by the loss of CD4+ T cells in the peripheral blood and lymphoid tissues. Viral entry into CD4+ cells is mediated by the interaction with a cellular chemokine receptor, the most common of which are CCR5 and CXCR4.1 Because subsequent viral replication requires cellular gene expression processes, activated CD4+ cells are the primary targets of productive HIV infection. Consequently, HIV infection leads predominantly to the depletion of activated memory CD4+ T cells, most of which reside in the gastrointestinal (GI) mucosa.2-4 Although therapeutic control of HIV replication allows the immune system to partially restore and delays disease progression, the cure of HIV infection remains still unachievable with use of the currently available antiretroviral drugs. The major barrier to viral eradication in patients receiving antiretroviral therapy (ART) is the establishment of HIV reservoirs, including low-level productively and latently infected cells.5-7 Thus, maintenance of replication-competent HIV in long-lived cells and distinct anatomical sanctuaries allows the virus to reseed the body once ART is discontinued.8

Cells of persons homozygous for the CCR5 gene variant Δ32 (CCR5Δ32/Δ32) are naturally resistant to infection with CCR5-tropic HIV strains (R5 HIV) because of the lack of CCR5 cell-surface expression.9 Previously, we demonstrated the feasibility of hematopoietic stem cell transplantation (SCT) with CCR5Δ32/Δ32 donor cells (CCR5Δ32/Δ32 SCT) in an HIV-infected patient with relapsed acute myeloid leukemia (AML) and documented absent viremia during the first 20 months of remission, during which time the patient did not receive ART.10,11 This case clearly emphasizes the importance for continuing research in the field of CCR5-targeted treatment strategies, but uncertainty has remained over whether a cure for HIV infection has been achieved in this patient.

In summary, our results demonstrate successful CD4+ T-cell reconstitution at the systemic level as well as in the largest immunologic organ after CCR5Δ32/Δ32 SCT and in addition provide evidence for the reduction in the size of the potential HIV reservoir over time. Although the recovered CD4+ T cells are susceptible to infection with X4 HIV, the patient remains without any evidence of HIV infection for more than 3.5 years after discontinuation of ART. From these results, it is reasonable to conclude that cure of HIV infection has been achieved in this patient. 041b061a72

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