From sci-fi to sci-fact: A few HIV studies are actually morphing
people’s genes. Though small, the trials have an ambitious goal:
getting immune systems to control HIV—eventually, the plan goes,
without an HIV combo. The therapies change the genetic material in your
white blood cells—mature CD4 cells in some cases, stem cells in
others—so they can disable the virus. They’re still in early tests but
are showing some promise. Meet two positive men—one a treatment
veteran, the other with no med resistance—playing guinea pig in
different studies (find these and others at www.clinicaltrials.gov).
The Longtimer
Timothy Spaulding, 47
Retired government worker
Lexington, KY
Diagnosed 1991
The History
I
changed meds frequently due to side effects. I also had adherence
problems due to job demands—so now I’m resistant to a slew of meds. By
2004, my options were few. Since then, I’d been doing OK on Fuzeon with
Viread and Combivir, but my numbers started sliding again earlier this
year. So my doctor found a gene therapy trial, and I became Patient No.
8.
The Theory
A gene inserted in my CD4s binds with HIV’s genetic material, preventing the virus from reproducing.
The Procedure
My
CD4s were harvested—a five-hour process. They extract whole blood out
of one arm. A machine removes the white blood cells. The rest is
injected back into the other arm. Then the CD4s are mixed with VRX496,
a distorted version of HIV. A few weeks later, the mixture is dripped
into my arm—it takes about 15 minutes. I’ve had three infusions so far.
I should get eight over 16 weeks. I stay on my combo.
The Results
The
day after each procedure, I feel fatigued, but then I snap back. After
the third infusion, my viral load was too high (and CD4s low) to get
the fourth. Recently it fell again. I got No. 4—and it seems I’m back
on track.
The Outlook
I
have hope. Every time I’ve hit bottom in my life with HIV, something
has come along to help. The worst case: This buys me some more years,
and by then I hope we’ll have a whole new class of meds—entry
inhibitors—available. Best case—the researchers say they will monitor
me for 15 years. I’d like that.
The Newcomer
Michael Delane, 41
Credentials manager
San Francisco
Diagnosed 2002
The History
At
diagnosis, my viral load was in the millions, CD4s at 924. I felt sick,
so I started meds. I was 100% adherent and got my viral load
undetectable, but my CD4s kept falling. My doctor called my HIV
aggressive. I want to be aggressive, too, so I signed up for a two-year
gene therapy study to obliterate HIV—right up my alley.
The Theory
My stem cells are genetically altered so they mature into CD4 cells that can resist HIV.
The Procedure
My
stem cells were harvested—slow but not painful—and genetically altered
to produce an enzyme (ribozyme) that attacks HIV at five points,
shredding it. Then the altered stem cells were infused back into my
bloodstream. I stayed on my meds until the new stem cells matured into
CD4s ready to stop HIV from infecting them
(it took 40 weeks). Then I stopped all meds.
The Results
That
was eight months ago. Today, without taking an HIV regimen, I’m holding
steady with an undetectable viral load and CD4s ranging from the upper
300s to mid-400s.
The Outlook
I
would do it again in a heartbeat. I don’t know if I’ll stay
undetectable forever, but these eight months have been great—no meds,
no side effects. I feel like I have control over this stupid monkey
virus. I have every confidence that science will soon prevail over HIV.
I’m happy to be a part of that.
