Kenyan doctor uses cancer drug to stop HIV progress

Dr Simon Barasa Situma of the Kenya Polytechnic University College.

What you need to know:

  • In May this year, this newspaper published a story on Dr Barasa Situma and his scientific study on HIV. We followed the progress of two of his patients and what Kemri had to say about their viral loads. Interestingly, lab results showed a progressive slowdown of the the virus’ progress until, eventually, it was undetectable and therefore deemed eradicated. Are we on the verge of an HIV cure? The researcher says this, indeed, could be it

Five Kenyans appear to have overcome the HIV virus, boosting hopes of getting a cure for the world’s deadliest virus. The five, who include two men and three women, seem poised to join a handful of other people believed to have been cured of the virus, says the man leading the clinical trials of the uncoventional regimen, Dr Barasa Situma.

Frequent lab tests have shown that the viral loads of the five, who were treated with methotraxate, a drug that works by suppressing rapid expansion of the specialised stem cells in the bone marrow — called hematopoietic cells — are now undetectable, raising hopes of a cure for a disease still deemed uncurable but manageable.

One of those who appear ‘cured’ through this process is 40-year-old Dorcas, a mother of one. (We cannot publish the full names of the patients quoted in this story to protect doctor-patient confidentiality and their own individual identities).

Dorcas, who tested positive in 2006, started taking antiretroviral medications to try and maintain a healthy lifestyle as directed by her doctor. And although the use of ARVs boosted her health, she says she did not see so much change on her body. And so, after five years, the symptoms of infection with the HIV virus began ravaging her body.

“I started feeling weak, had no appetite and my hair began to thin,” she says. “And then I started getting these persistent joint pains and muscle soreness that almost crippled me.”

ALTERNATIVE WAY

Buoyed by a desire to stay alive, Dorcas tried to see if there was an alternative way of reducing the raging virus in her body, and her enquiries led her to Dr Barasa, a practising pharmacist and lecturer at the Technical University in Nairobi who has also been researching the HIV virus for years now.

“He insisted that he had to first test me to confirm my HIV status,” says Dorcas, “then requested Amref, who had been monitoring my progress, to forward him my medical history. He then put me on treatment and, after six months, I noticed some improvement. A year later I feel better and tests have shown that I am free of the HIV virus.”

The Kenya Medical Research Institute (Kemri) has also confirmed that she is indeed HIV negative. Test reports seen by DN2 show that Dorcas, who tested positive about seven years ago, has no traces of the virus in her blood cells.

“It’s very interesting,” says Kemri in a statement on Dorcas’ apparent cure. “We are not sure how this happened, but it’s true that the lady (seems) cured of HIV. She was referred here by Crescent Medical Aid Kenya, located on Murang’a Road, and it took us more than a week to monitor the tests and confirm that she was, indeed, free of the HIV virus.”

Cresent Medical Aid Kenya offers a wide range of services, including HIV testing, monitoring and counseling, among others, and Dr Barasa monitors his patients with the help of this accredited hospital.

Another patient who has shown signs of cure is Nancy, a Nairobi businesswoman who got exposed to the virus around mid-January this year. It took her a few weeks to realise something was not right with her, so she confronted her sexual partner who confessed that he was HIV-positive and on ARVs.

This prompted her to go for a test at Nairobi Women’s Hospital, where she found that she was negative. The doctor, however, told her to return after 90 days since it takes three months for the virus to be detected in an antibody test, or what is commonly referred to as a VCT test.

However, Nancy could not wait for 90 more days to confirm her status, and so she did further tests in four different hospitals to be sure of her condition. She still tested negative.

Unsure of herself and wary of the fact that she had been exposed to the virus but tests showed she was okay, she sought the advice of Dr Barasa, who referred her to Lancet Lab, located in the Upper Hill area of Nairobi, for a viral load test to determine if she had any trace of the virus.

HER WORST FEARS
Nancy instead decided to go to Kemri, and it is at one of Kenya’s most advanced laboratories that her worst fears were confirmed. She was HIV-positive.

Crushed, frustrated and angry at herself, she returned to Dr Barasa, who again sent her to Lancet Lab to confirm the quantity of the virus in her body. Documents show that the lab detected 38 copies/ML of the virus, and Dr Barasa immediately started her on his treatment process.

After three months of follow-up and intensive treatment, coupled with consistent laboratory monitoring, Dr Barasa sent her back to Lancet Lab for further testing, and her results came out as ‘undetectable’, implying that she had very little virus in her body to be detected.

Six months after the exposure, Nancy decided to do another HIV antibody test at Crescent Medical Aid Kenya and it turned negative. Dr Barasa then asked her to return to Kemri for a test similar to the one she had done in March 2013.

The results not only shocked her, but also the staff at Kemri. Nancy was HIV-negative! Antibody tests on her still turn negative and consecutive visits to Kemri have confirmed the same.

So, is this it? Are we on the verge of an HIV cure, or is Dr Barasa’s cocktail of drugs playing a wily game with Kenya’s laboratories?

The researcher believes he is onto something huge, and that this, really, could be it. He, however, advises that, for the ‘cocktail’ to be effective enough, the patient must be started on it early enough.

People who are already exposed but cannot test positive in an antibody test, he says, should do further tests — such as a viral load test — to verify if indeed they have traces of the virus in their bloodstream.

This would ensure that doctors have a clear history of the patient and can easily monitor progress.

In May this year, this newspaper published a story on Dr Barasa and his scientific study on HIV cure.

Dorcas was one of the first patients who formed the basis of that article and, because of that story and the huge prospects of his lab work, Dr Barasa attracted a lot of foreign interest, with international scientists expressing desire to understand how his ‘functional cure’ could be taking the world closer to a true cure of the virus.

The Berlin Patient

Dr Barasa, however, says this is not an outlandish, grossly unconventional effort because the treatment he applied to Dorcas and the other patients was based on the world’s first known cure of HIV: that of Timothy Ray Brown of San Francisco, who is also known as ‘The Berlin Patient’.

Forty-seven-year-old Brown was diagnosed with HIV in 1995 and put on ARVs but in 2006 developed leukemia — blood cancer — and for that reason was given a bone marrow transplant with a rare gene mutation that provides natural resistance to HIV.

His doctor, Gero Hutter, said this resistance seemed to have been transferred to Brown. But Dr Barasa disputes the doctor’s assessment of the cure of Brown, arguing that it was the removal of the patient’s bone marrow that did it.

“Removing the bone marrow, where the CD4 cells replicate, denied the virus the capacity to replicate and, consequently, the patient was cured of HIV,” he argues, adding that he has demonstrated ‘HIV cure’ in his five patients by stopping rapid multiplication of CD4 progenitor cells in the bone marrow, where the HIV virus hides to avoid elimination by the immune system.

If the claims are true, then this Kenyan researcher will have achieved the first complete cure without bone marrow transplantation anywhere in the world.

“Bone marrow transplantation is a very expensive, specific and dangerous procedure, which makes Brown’s treatment impossible to apply to the more than 30 million people with HIV,” he says. “But I think purging the virus from some specific locations where it seems to hide is the way out to eradicate it.”

Medical doctors using antiretroviral drug therapy are able to bring down a patient’s viral load to undetectable levels, but once the patient stops the medication the viral load goes up again. This means there is a reservoir in the body where the virus is hiding and the ARVs are not able to reach, which turns out to be in some parts of the bone marrow.

“Get rid of this reservoir and, theoretically, you are home and dry,” says Dr Barasa.

And so, to attack that seemingly impossible-to-reach reservoir, he uses a technique that comprises the use of the cancer drug methotraxate, in combination with other agents, to eliminate the virus hiding in the bone marrow.

Methotrexate is used to treat cancer but is indicated to have very serious side effects, thus should not be used without advice from a competent physician. Dr Barasa chose it for his trials after a retrospective study showed it to be most useful for lymphomas, which are a type of cancer affecting lymphocytes.

Killing cells

He reasoned that since the HIV-infected bone marrow niche is thought to contain lymphocyte progenitors with extremely high cell turnover, the drug would be useful in killing these cells and thus stopping the perceived progenitor-to-progenitor infection cycle responsible for the maintenance of this reserve infection.

Viremia from other infected tissues could re-infect the bone marrow if it were not removed, and literature studies have shown infection of the bone marrow probably occurs at persistent high viremia, providing an opportunity for viral trafficking by CD4 lymphocytes into the niche.

Viral control by appropriate antiretroviral therapy prior to and during the procedure, with maintenance of a robust immune function, ensures clearance of the secondary viral reservoir.

“The treatment consists of a combination of agents that are given in a way that is tailored to suit individual patients alongside continuous laboratory monitoring, and although the drug is available in local pharmacies on prescription, it must never be used without clear instruction from doctors,” says Dr Barasa.

Within two weeks after going through the programme, he says, his patients started showing tremendous improvement and healing of symptoms related to HIV/Aids, then recorded undetectable viral loads in their blood after between eight and 10 weeks.