Patient given nivolumab, a new generation cancer drug, shown to have a reduced reservoir of dormant HIV cells and a boosted immune response
A new generation cancer drug has raised hopes for those living with HIV after it was found to reduce the reservoir of dormant HIV cells in the body and boost the immune response of a patient.
Doctors say the effect the cancer drug nivolumab appeared to have on the patient offers a tantalising hope that it might provide a way to eradicate the virus from patients.
This first report of a successful depletion of the HIV reservoirs opens new therapeutic perspectives towards an HIV cure, the authors of the study write in a letter to the journal Annals of Oncology.
The results are based on findings from a 51-year-old man who had HIV since 1995, and was being treated for lung cancer. After relapsing less than six months after surgery and first-line chemotherapy, he was given the drug nivolumab.
The man then showed a dramatic reduction in reservoirs of HIV-infected cells and increased activity from CD8 killer T-cells, a key immune system attack weapon.
This is the first demonstration of this mechanism working in humans. It could have implications for HIV patients, both with and without cancer, as it can work on HIV reservoirs and tumour cells independently, said Prof Jean-Philippe Spano, head of the medical oncology department at Piti-Salptrire Hospital AP-HP in Paris, who led the research. The absence of side effects in this patient is also good news, and suggests this could be an optimum treatment for HIV-infected patients with cancer.
But, the team also urge caution, noting that in another patient with HIV where nivolumab was administered there was no drop in the reservoir of dormant cells, while they also note the need to study the toxicity of such drugs in those with HIV.
The drug appears to have the effect of waking up white blood cells that are infected with HIV but which are lying low in reservoirs around the body and are not producing HIV. In this state the cells are unable to be attacked by anti-retroviral therapy or the immune system, but when reactivated and the cells start to produce HIV they can be.
Increasingly, researchers have been looking into the use of certain drugs that appear to re-activate the latent HIV-infected cells, said Spano. This could have the effect of making them visible to the immune system, which could then attack them.
If the reservoirs are cleared of dormant infected cells, patients could potentially be cured.
The patient, the team note, has been given 31 injections of nivolumab, administered every 14 days since December 2016. While the mans HIV levels initially increased, they then dropped and the activity of certain T-cells, including CD8 killer T-cells, rose.
By 120 days after treatment began the team say a dramatic and sustained drop in the levels of dormant infected cells was observed.
Experts warn it is too soon to celebrate, noting that it was not clear if the reservoirs would regrow, and that results from other cancer patients with HIV who had been given nivolumab were as yet unreported.
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