Front Burner - Despite reported 'cure', the fight against HIV continues

Episode Date: March 8, 2019

This week, a major milestone in HIV/AIDS research made headlines worldwide. A man known as the "London Patient" has seemingly been "cured" after receiving a bone marrow transplant from a donor with an HIV-resistant genetic mutation. It's only the second time in history a procedure like this has been executed successfully. But while some doctors are inspired by this week's breakthrough, others are more cautious in their optimism. Today on Front Burner, we track the historical battle against the virus and what it means for future progress with help from Canada Research Chair in HIV Pathogenesis and Viral Control, Eric Arts.

Hey there, I'm David Common. If you're like me, there are things you love about living in the GTA and things that drive you absolutely crazy. Every day on This Is Toronto, we connect you to what matters most about life in the GTA, the news you gotta know, and the conversations your friends will be talking about. Whether you listen on a run through your neighbourhood, or while sitting in the parking lot that is the 401, check out This Is Toronto, wherever you get your podcasts. This is a CBC Podcast. Hi, I'm Leah Simone Bowen.

And I'm Phelan Johnson. And we're the hosts of The Secret Life of Canada, a history podcast about the country you know and the stories you don't. That's right. Season one, we discovered some really eye-opening things like Banff was built by POWs. And that pizza pops are Canadian. And that Canada had 200 years of slavery. Join us for season two on CBC Podcasts as we dive even further into the undertold and untold history of Canada. Hello, I'm Jamie Poisson. This week, a remarkable story lit up the usually grim news agenda.

It was about a man known only as the London patient. And he's now reportedly free of HIV, the virus that causes AIDS, seemingly cured after receiving a bone marrow transplant. New hope in the battle against one of the world's biggest challenges, HIV. One of the researchers says he's over the moon. The treatment has been discontinued now for around for 18 months and there's still no virus in his body. It's only the second time in history scientists have been able to successfully execute a procedure like this. Today we'll look at how we got here, and why the promise of the London Patients' Cure might actually not be enough to really win the fight against HIV-AIDS. Hopefully it's a cure, but it's not something that is practical around the world to cure the 37 million people infected today. I'm talking to Eric Arts. He's the Canada

Research Chair in HIV Pathogenesis and Viral Control and a professor at Western University. This is Frontburner. Hi, Dr. Arts. Hello. So I'm hoping that we can start here. Essentially, how did health officials first become aware of what would eventually become known as HIV AIDS? It was a very complicated time, and this was in the early 80s, around 1981. And the difficulty was at the time that there were gay men. They were coming in with this rare immunodeficiency disease.

A killer loose on the streets of New York. The search continues. streets of New York. The search continues. As a consequence, it was completely inexplicable as to what they were dealing with. And it was such a rare form of immunodeficiency that they were presenting with in the hospital. The doctors didn't really know what was going on. It's a new and strange disease. It kills and there's no known cure. Doctors in Vancouver are worried that it could hit here next. And as more and more gay men came into hospitals in San Francisco and New York, there's a pattern evolving and there's a lot of people trying to figure out what was going on at the time. And it didn't take long before there was a realization it was probably an infectious agent. And so from there, the hunt was on as to what it was.

Cy Gabrodilla has an obsession. He's tracking a killer. The Centers for Disease Control Atlanta. Here, Erskine Palmer spends endless hours searching for what science increasingly believes is a virus. How is the medical community able to establish what actually caused it? The difficulty in HIV AIDS, and at the time was known as grid disease or grid, was that the disease actually presents itself symptomatically very late. So people could have been infected for five, six years. So to do contact tracing in that respect is very difficult. It's not like Ebola where people basically succumb to the disease very rapidly and you can look at contacts just a few

days before. So it's difficult then to know where people contracted it in the beginning, is essentially what you're saying. Eventually that realization came to be, and then they started doing things like closing bathhouses and trying to prevent that mode of transmission. But at this time, still they didn't know what we call the etiological agent, what was responsible for this disease. And there was quite a bit of hysteria in those early days. One of them is a medical epidemic, a baffling new disease called AIDS. And the other is an epidemic of fear. In some large U.S. cities, the fear is turning into general hysteria.

I was pretty young at that time, but I remember it very vividly. Can you tell me a little bit more about this hysteria? Well, it then perpetuated once we knew what the infectious agent was, which was HIV. And you get situations like the case of Ryan White. Ryan White still has a paper route, still goes to movies, but now can't go to school. White still has a paper route, still goes to movies, but now can't go to school. Where suddenly they found out that Ryan White was HIV infected through a blood donation. And suddenly there was an incredible social stigma placed on Ryan White and nobody wanted to go to school with him.

Well, if the doctor says it's okay, you know, I see no reason why, you know, they should be afraid. He and his parents went to court to try to force the school board to change its mind. They lost. Ryan's mother says in Kokomo he was ridiculed for having AIDS. Other parents raised money at an auction to pay for a court fight to keep Ryan out of school. When that failed, more than 40% of them pulled their kids out of class. The White family moved away.

There was lots of instances like this where you didn't want to shake a gay man's hand because you were fearful that you might get the virus. And that stigma still exists today. It's remarkable. And you mentioned that the disease was initially called GRID, Gay Related Immune Deficiency. In those early days, was the belief that the only people that could contract this were gay people and then maybe people who had blood transfusions?

Yeah, that was the case. Until we started to discover that this disease, very similar symptoms, was popping up in sub-Saharan Africa, in countries like Uganda. And when that was realized, then the whole ballgame changed, if you will, in the sense that we knew that those people were not contracting the disease, at least the majority were not, through gay-related sex or men who have sex with men. And I know around this time, you mentioned before this hysteria around the disease

and how people didn't even want to touch people who might be infected with HIV, which is something that persists today. But there was also this really growing social movement that included demands for access to drugs and some of them experimental. And then there were all of these famous people that came forward, Freddie Mercury. And I also remember there was this very famous moment with Princess Diana, where she shook hands with an AIDS patient. The Princess of Wales felt not the slightest apprehension about her visit to the Middlesex Hospital and its AIDS ward.

As she entered, to the delight of the staff, she clearly wasn't wearing gloves. And she shook hands with all the nurses, doctors, and all ten patients on the ward. And why do you think that this was important culturally, but also for the medical evolution of how HIV is dealt with? You may identify with someone that you knew in your community or in your friend group that may have been HIV infected. But I do remember back then, even friends of my parents, whose son or daughter may have been infected, mostly sons at that time, there was just a quiet hush about it.

So it really required people to come out and broadcast the news of them being infected to really create awareness. And I can't remember how long it took for Ronald Reagan to actually acknowledge and even mention publicly the HIV-AIDS epidemic. I want to talk tonight about the disease that has brought us all together. It took something like five years before he actually signified that that was an issue. And the epidemic had already killed probably about 30,000, 40,000 people in the U.S. So, and then, yes, Princess Diana was also a very big advocate for the AIDS epidemic. As a consequence, all of these celebrities coming out

really inform the public that, yeah, if you are considering this social stigma and really, you know, treating someone differently because they're HIV positive, well, to be blunt, you're just stupid. And you should recognize that they're just a normal person that accidentally got infected by this virus. What do you think all of this social awareness around the disease did to help the treatment of it? Organizations like ACT UP were incredibly important. It was amazing to see the activism and the pressure they, in particular, of the marginalized, impoverished populations in the US and Canada and Europe. Now, of course, you know, ACT UP, as great of an organization they were, they didn't do as much, I would say, early on for the plight in Africa. And in some ways, we saw the African epidemic exploding. And for the most part, the Western world in the late 80s and early 90s were not

paying attention. I want to get to other parts of the world in a minute. But can we talk about what was happening in the late 80s and 90s here in Canada and also in the United States? You know, I know that you mentioned that there's a lot going on around this time, but also, you know, this is a full pandemic in the United States around this time. It's the leading cause of death for all Americans ages 25 to 44. And here in Canada, we have 33,000 people who are living with HIV AIDS. And so what happens here to deal with this crisis, essentially? One of the remarkable things in the early 80s, and even in the late 70s, we thought that cancers were caused by a virus very similar to HIV, which we call a retrovirus.

And it turned out that that was not the case at all. There's a few rare exceptions of where retroviruses cause cancer. But due to the research in that area, they had developed these drugs that they would hope to have used as chemotherapeutic agents. And one of those was AZT or zidovudine. Of the 3,200 volunteers in the San Francisco-based test, those so mildly affected they had no symptoms of AIDS and given AZT showed resilience fighting the disease. It's interesting because AZT from being tested to being

approved is the fastest drug approval in history for the FDA. And so that really relates to the pressure that ACT UP was placing on the governments, on the pharmaceutical companies to get something like this out. But we can't also ignore the economic benefits to pharma companies at the time. A drug for HIV with the potential of treating thousands and potentially millions of people around the world had market values of well over a billion dollars a year. And if you could... Right, huge incentives there for them to move quickly. Absolutely. And if you can pull it off the shelf, it's a lot easier than putting tons of money in research and development. Now, after that point, there was an incredible fury in developing new drugs. And one of the ones was, which was approved in 95 and turned out to be almost a miracle drug. And that was a 3TC or lamivudine. And that was developed by a company, Biochem Pharma in Montreal.

And this is essentially Canada's greatest contribution to fighting HIV AIDS. I think so. I think the development of 3TC really pushed forward the current treatments we're using today. And even up until recently, 3TC was one of the most prescribed drugs in the world. And so we've got these drugs, and they're making this incredible headway in fighting AIDS in the 90s and early 2000s. Drug companies, essentially, there was a fire lit under them, perhaps because of these social movements and also because of economic reasons, if I'm summing up what you've said properly. That's absolutely true. The three drugs with 3TC or lamivudine made by Biochem Pharma,

that was the key to getting us where we are today. And, you know, if three drugs didn't work, And, you know, if three drugs didn't work, we were almost out of options. We were really scared. And fortunately, it worked. And now we have successful treatment for HIV. And how did these drugs help the AIDS epidemic in Africa? That is almost another story. But in the early 2000s, potentially 20, getting close to 30 million people infected in sub-Saharan Africa, people don't understand how devastating

that is. I mean, if you're walking on the street, every third person you meet, you might be encountering an HIV-infected person. And that HIV-infected person, unless they were going to receive treatment, were going to die within the next five years in all likelihood. So it took a while before the world woke up and said, no, it's unfair that we're saving all these people's lives in North America and Europe, and nobody is getting that treatment in Africa. And the reason why was because the treatments, even today in North America and Europe, are somewhere around $20,000 a year just for the drugs. So it really took an incredible amount of pressure by the governments. And, you know, I also credit Mark Weinberg.

He was the president of the International Aid Society at the time. And this gives us another Canadian reference. And what Mark did is he said, okay, enough's enough. We have to bring the International AIDS Conference to South Africa. We need to bring it to Africa where the epidemic has hit the hardest. The Durban Conference highlighted throughout the world that it was not acceptable to have two different worlds, world that it was not acceptable to have two different worlds. One world in which everybody could take access to antiretroviral drugs for granted, and a different world in which the drugs

were virtually non-available, which meant that anybody who contracted HIV in a developing country setting was more or less, at the time, condemned to die. And there was a lot of reluctance. A lot of people from North America didn't want to come. And when it did happen, it all changed. Suddenly, there was an incredible level of activism. The press reported on it heavily. This year's International AIDS Conference in Durban, South Africa is the 13th global session on the disease.

It's also the first to be held in Africa. And then finally I remember, you know, crying my eyes out at the closing ceremony because Mandela spoke. A tragedy of unprecedented proportion is unfolding in Africa. And spoke with such eloquence and with such conviction. And I knew then that things were going to change. It was remarkable, magical. is claiming more lives than the sum total of all wars,

famines, and floods, and the ravages of such deadly diseases as malaria. So, listening to you, it's clear that you feel like we have a lot more work to do in our fight against HIV and AIDS. But one of the reasons we're talking to you today is because of the headlines that we've been seeing the past week, which is essentially that a patient has been cured, the London patient. The findings show the patient went into long-term remission. So in other words, that person was essentially cured. And this is essentially the second person who has been cured. We now know it wasn't a fluke. It's happened again. The first came in 2007, a man named Timothy Ray Brown, the Berlin patient. My case, my history is proof and concept that HIV can be cured.

Hope is alive and cure is on the horizon. This London patient doesn't yet want to be identified. And so can you take me through what's happened here? And why do you think this isn't the answer? Yeah, so what happened this week is very similar to what happened with Timothy Ray Brown, or what we call the Berlin patient. It's a very simple approach. This London patient had developed cancer while being infected with HIV. So in this case, the best way to treat Hodgkin's lymphoma is to do a bone marrow transplant.

So really what they did was similar to what they did with the Berlin patient. They looked around for someone that is what we describe naturally resistant to HIV. Their cells can't be infected with HIV. And so what they did was they took that patient's stem cells, which emerge into cells that are resistant to HIV, and they placed those cells into the bone marrow of this London patient. And eventually those cells, the donor cells, dominated the immune system and became the new immune system in this patient. And eventually those cells, the donor cells dominated the immune system and became the new immune system in this patient. And as a consequence, the virus, that HIV that was in that

patient can't find a home, can't replicate anymore. And so this patient so far, and many of us are placing a caveat on that because it hasn't been that long, but so far that patient, there's been no rebound of the virus and that patient is clearly in remission and potentially could be cured like Timothy Brown has been. good physical health and recovered very well after the transplant. Obviously, he was sick during that procedure and hospitalized. But since then, he's made a very good recovery and is leading a full and relatively normal life. So is this something that can be replicated to deal with all these other HIV-AIDS cases around the world? Because listening to you talk in this conversation, it doesn't seem like you think this is the way forward to pursue this kind of treatment that cured these two men. Yeah, so this is definitely a cure. No question,

in the sense, or hopefully is a cure. It has been for Timothy Brown, but it's not something that is practical around the world to, you know, cure, you know, the 37 million people infected today. And the reason why is, first of all, we don't normally do complete immune system destruction in anyone that is relatively healthy to introduce stem cells into bone marrow from another donor because it's just too risky. Most of the people that are infected with HIV and on these one pill a day regimens are completely healthy. That doesn't mean that they don't want to be rid of the virus.

Because of the stigma attached with being HIV positive, they clearly don't want to be living with the virus and knowing that if they ever stop taking their drugs, the virus will rebound and cause disease. So, but it's not a practical cure. You know, I'm struck by this conversation today, which, you know, we went over what feel like incredible milestones to me in the fight against HIV AIDS. You know, a disease that, you know, some 35 years ago we just discovered. You know, it is really incredible to think that today people can live relatively normal lives with this disease. But, you know, at the same time, and there is maybe this sense that we sort of have this under control. You know, there are headlines this week about a cure and, you know, what I just mentioned, the idea that you can live a normal life.

And, you know, what I just mentioned, the idea that you can live a normal life. But, you know, I do pick up that you say that 37 million people are still living with HIV, you know, and not everybody has access to these drugs, even here in Canada. And so do you think that this is like a misnomer, this perception that we've sort of got this? I think it's misinformation at its worst, not because the results aren't exceptional. And I've read the paper. It's a wonderful piece of work. And I really think they've done something great for this patient, but it's not applicable to the population. And I think we miss the mark. I mean,

what people don't understand is, interestingly enough, with all this treatment, we're treating 18 million people. We've actually reduced the death rate of HIV. So we're at a peak of about 2 million a year that were dying of HIV. We now reduce that to less than a million. a year that were dying of HIV. We now reduce that to less than a million. One thing we haven't done effectively is reduce the new infections. The number of HIV infected patients in the world is still increasing. It's not decreasing. It's obvious that we need a vaccine to help control this. We've never survived an epidemic of this magnitude without not having a vaccine. So we need a cure. I mean, we need to do something to cure those patients that are HIV infected for the stigma they face, for their life. Dr. Arts, thank you so much.

No problem. Thank you, Jamie. That's all for today. FrontBurner comes to you from CBC News and CBC Podcasts. The show is produced by Chris Berube, Elaine Chao, Shannon Higgins, and Abby Plenner, with help from Aisha Barmania. And a very special thanks this week to Dexter Brown, Salmon Malik, and Laura Antonelli, and our Ottawa Bureau for all their help. Derek Vanderwyk is our boss of sound. Our music is by Joseph Shabison of Boombox Sound.

The executive producer of Frontburner is Nick Bacay-Blocos. This week, he wouldn't let us run any decent Jerry Butts puns, so that wasn't super cool, but normally he's okay. And I'm your host, Jamie Poisson. Thanks for listening to FrontBrunner. For more CBC Podcasts, go to cbc.ca slash podcasts. It's 2011 and the Arab Spring is raging. A lesbian activist in Syria starts a blog. She names it Gay Girl in Damascus.

Am I crazy? Maybe. As her profile grows, so does the danger. The object of the email was, please read this while sitting down. It's like a genie came out of the bottle and you can't put it back. Gay Girl Gone. Available now.