Rethinking the Definition of Cure as Patients With HIV Wait – Medscape

BOSTON A year ago, a man living with HIV walked into the exam room of Maile Young Karris, MD, from the UC San Diego Medical Center. He had seen on the news that there was a cure for HIV, and asked Karris: "How can I get it?"

Karris, who specializes in HIV primary care, explained that although one man then known as the London patient had been off medication for 18 months and remained in remission, that cure, if it were really a cure, was not available to him or, really, to any other patient with HIV.

"I'm often very hopeful. I believe we will get there," she told Medscape Medical News. "We're sort of just one scientific advance away."

But back then, she had to explain that the London patient, like the Berlin patient before him, had to get to the point of almost dying from cancer before the stem cell transplant that changed his immune system was even a possibility, and that both men had undergone a painful and invasive immunologic makeover.

So when it was reported at the virtual Conference on Retroviruses and Opportunistic Infections (CROI) 2020 that the London patient, now identified as Adam Castillejo, is still in remission a year later, even the researcher who performed the transplant was willing to say it's probably a cure.

But that likely won't change the way Karris or other HIV providers care for patients.

When Ravindra Gupta, MD, from University College London, presented the case of the London patient at CROI 2019, he was very careful to say "remission", not "cure".

But when he presented the case at CROI this year, he called it a cure, and he and his colleagues, in their report of the evidence published in the LancetHIV, state that "these findings probably represent the second recorded HIV-1 cure."

In May 2016, Castillejo received a stem cell transplant to treat stage4 Hodgkin's lymphoma, a non-AIDS-defining cancer. That transplant, like the one that Timothy Ray Brown, the so-called Berlin patient, received contained stem cells with two genetic mutations that remove the CCR5 receptor from the surface of the T-cell. Without that receptor, most HIV strains can't invade cells and, therefore, can't proliferate.

When Gupta presented preliminary findings last year, Castillejo had only been off HIV treatment for 18 months and was nearly 2 years out from his transplant. Back then, the team only took blood samples, but they showed that HIV wasn't present.

Then, just last month, samples from Castillejo including blood, plasma, semen, and tissue from his rectum, cecum, sigmoid colon and terminal ileum, and auxiliary lymph nodes were subjected to DNA, RNA, and other testing to see if the virus really was gone.

Although Castillejo's T-cell count is starting to approach where it had been before the transplant, there is no evidence that HIV is replicating in the blood, semen, or tissue samples tested, Gupta reported.

There were remnants of HIV genetic sequences in T-cells and in lymph node samples, though.

"Those can be regarded as so-called fossils," artifacts of past infection, not proof that HIV was still alive in his system, the researchers explain in the published report.

The findings are exciting, said Sharon Lewin, MBBS, PhD, from the Peter Doherty Institute for Infection and Immunity at the University of Melbourne in Australia, who was not involved in the study.

"It makes me think about a new definition of cure," she told Medscape Medical News. It's "the idea that clearing intact virus is what we're doing. And people may well have defective remnants of the virus, but that defective remnant can't replicate."

Of course, this is all still conjecture, she acknowledged. No one knows how long someone has to follow a person like Brown or Castillejo to know for sure that it will never come back. But she seems reassured that Castillejo had made it past the 27-month mark, which is when the viral load of the Mississippi baby rebounded.

When Gupta presented data on the London patient last year, "it was electric," said Rajesh Gandhi, MD, from Massachusetts General Hospital in Boston. "I think most of us remember where we were."

So it's probably not a surprise that people living with HIV were also electrified. It was a topic that popped up in many exam rooms, which some clinicians blamed on newspapers headlines such as "HIV Is Reported Cured in a Second Patient."

And even for patients who weren't asking directly for a stem cell transplant, the question of cure was urgent for many of them.

"I think most of my patients weren't thinking that it is so easy that they want to go through the rigors of chemotherapy," Gandhi told Medscape Medical News. But "people have definitely come in to my clinic asking: 'What type of cure research are you doing?'"

Gandhi said he directs patients back to what does work: a single pill a day to control HIV.

Right now, Gandhi has a patient who has had both cancer and HIV. The cancer is now gone, but the HIV remains. The patient shared his cancer diagnosis with family but still hasn't disclosed his HIV status.

"He could get all the support from his family around cancer, but he never could share his HIV diagnosis," Gandhi said. "I think this is what motivates people to ask about the London patient and the Berlin patient."

People are still afraid of HIV.

Karris has noticed the same thing. Not long ago, a woman came to the clinic and reported that her partner had pulled a knife on her.

"He'd found her HIV meds in her purse and looked it up," Karris explained. "He took a knife to her because she didn't disclose. He said he was going to cut off her fingertips."

The woman has a suppressed viral load, meaning she can't transmit the virus to her partner. California changed its criminal code in 2017 to make HIV nondisclosure a misdemeanor instead of a felony.

"People are still afraid of HIV," Karris said. "Some people hate the idea that they have HIV. This is one reason people stop taking medicine. They tell me: 'I hate coming here. I don't feel sick. And when I come to the clinic, I'm reminded I'm sick. When I take my meds, I'm reminded I'm sick'."

For patients who feel that way, she has three things to offer. One is the concept of undetectable equals untransmittable, meaning that they aren't putting the people they care about in the position to acquire HIV. That's been transformational for many patients, she said.

The second is that new HIV medications are coming soon that will be taken every month or every other month. "That seems helpful for them," she said. "They like the idea of coming in once a month. Then they don't have to think about it every day."

And finally, she said, she's excited to share a new tidbit, also presented at this year's CROI, that people who have CD4 a T-cell count of at least 500cells/mm3 when they start taking medication now have an average lifespan just 3 years less than those in the general public.

"The gap is closing between people living with HIV and those without," she said. "I try to communicate that. It can be mind-blowing for them, to see that they could live as long as anyone else."

Conference on Retroviruses and Opportunistic Infections (CROI) 2020: Abstract346. Presented March10, 2020.

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Cancer and COVID-19: What you should know – Newswise

Newswise The number of COVID-19 cases are expected to continue to grow across the globe in the upcoming months and that means more people will have to take extra measures to help protect themselves and reduce the transmission of the disease. This is particularly important for people with cancer, whose immune systems have often been weakened by their cancer treatments.

But does that mean people with cancer should stockpile hand sanitizer and face masks?

Oncologists Gary Schiller, MD, and Joshua Sasine, MD, PhD, help explain what cancer patients need to know about COVID-19.

Dr. Schiller is a professor of hematology/oncology at the David Geffen School of Medicine at UCLA and director of the hematological malignancies/stem cell transplantation unit, and Dr. Sasine is an assistant professor of medicine and director of the CAR T cell program at the UCLA Jonsson Comprehensive Cancer Center.

Which cancer patients should be concerned about coronavirus?

Sasine: The patients most at risk are those with bone marrow cancers or who have had a bone marrow transplant within the last 12 months. If patients have cancer and are on active chemotherapy, they are also at a higher risk than the general population. This is especially true if they are over the age of 60.

Schiller: Bone marrow transplant recipients who received bone marrow from other people are the most immunocompromised patients we take care of and the group at greatest risk for sustaining a life-threatening complication from an infection.

What does it mean to have a compromised immune system?

Sasine: The body's white blood cells normally clear out infections, like bacteria, viruses, and fungi. When the cells have either decreased in number, function, or both, the immune system is compromised. This can be due to having cancer, HIV, getting chemotherapy, and many other situations. This means that a person is more likely than others to contract an infection and the infection is likely to do more harm than average. It might also last longer.

Are there precautions cancer patients should be taking?

Schiller: Patients who are immunocompromised need to be wary of going into crowds, should maintain good hand washing techniques and should stay away from individuals who have a cough.

Sasine: For most events, canceling plans is ideal. However, sometimes one must weigh the risks and benefits. If there is a very important event (son or daughter is getting married, etc.) this might be a risk worth taking.

Should cancer patients delay travel plans?

Schiller: For patients with malignancies of the blood and bone marrow, and patients who had bone marrow transplants, I absolutely tell them to delay travel. Dont travel right now.

Is it safe for patients to come to the hospital and clinics for treatment?

Schiller: Yes. Weve been working to develop better isolation procedures and policies to isolate the potentially sick patients from our immunocompromised patients. For example, bringing the potentially sick patients in through a different entrance to isolate them in the waiting room and put them in an isolation room for evaluation.

Should patients be wearing a mask or stockpile hand sanitizer?

Schiller: A mask is not sufficient protection and were concerned that if you wear a mask, especially one that is insufficiently protective, then you have a false sense of security and you may put yourself in a position that might compromise your safety. In regards to hand sanitizer, I would like my patients to stockpile on soap and water. That would be more effective than using hand sanitizer repeatedly.

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Dr. Michael Everest: The Philanthropist With Undying Passion In Improving Medical Training And Research Programs Globally – Yahoo Finance

Los Angeles, CA, March 13, 2020 (GLOBE NEWSWIRE) -- Dr. Michael Everest is known for his life-changing efforts in supporting initiatives on medical education. He is an American Indian doctor. He faithfully allocates millions of dollars to get solutions to the leading health challenges the world faces through his Everest foundation, a nonprofit global organization that he serves as the chairman. The foundation is named after his father, who strongly advocated for education and believed that medical education should be one of the key focuses in every country. One of the foundation's programs, the Everest scholars, connects medical students and graduates from all over the world to top players in the health sector, such as teaching hospitals, and top-rated medical schools in the United States. Michael Everest seeks to advance medical innovation and philanthropic methods in medical research.

Some of the research areas funded by the organization include nanotechnology and stem cell technology. Still, Dr. Michael Everest has made significant contributions to stem cell technology, which has the capability of treating cancer, stroke, spinal injuries, and Alzheimer's disease. He sponsored the 5k walk/run. All the participants of the walk were wheelchairs users who have spinal injuries. Michael Everest formed a partnership with the Bronx VA exoskeleton and science research department, where he funded one of their stem technology projects. The project has already started to bear fruits. Several people who couldn't walk due to spinal injuries can now walk comfortably. Undoubtedly, such projects are life-changing. He also sponsors such medical events every year.

Dr. Michael Everest holds a strong belief that medical research initiatives are paramount for people from all parts of the world. For this reason, several medical trainees in the Keck School of medicine have benefitted mainly from his foundation. Dr. Michael gifted the medical school with $1m. The gift has backed up research in the institution. The donation has been of much help in the otolaryngology department, which researches the head and neck. The contribution will also enable the institution to carry out advanced research for years to come. Part of it will also benefit the children's hospital of Los Angeles, which has some connections with the Keck School of medicine.

Story continues

Importantly, Dr. Michael Everest has played a significant role in the promotion of medical initiatives in third world countries. Michael Everest makes donations to community-based hospitals in third world countries, which entirely rely on their governments for funding. The contributions enable the hospitals to take necessary research, benefitting the whole community. Through his foundation, he has sponsored quite a good number of hospitals in those countries. He understand s that in most third world-class countries, medical schools offer science training on basic levels, as they cannot afford state of the art research facilities. To solve the problem of half-baked medicine graduates, Michael Everest sponsors the graduates so that they can acquire the necessary research training.

One of his recent initiatives involves backing up pathology training for medical graduates from different parts of the world. True to his words, Dr. Michael Everest donated $500 000 to the University of California. Other institutions that have benefitted from the Everest foundation include the New York medical school, the University of Texas, Stanford University, and many other higher learning institutions. The sponsorships are in the form of residency fellowships, grants, research fellowships, and gifts.

Michael Everest's mission is to advance medical research on a global level. He believes that medical innovation, the advancement of research equipment and methods will be of benefit not only to the current generations but to the coming generations.

Contact@michaeleverest.com

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Dr. Michael Everest: The Philanthropist With Undying Passion In Improving Medical Training And Research Programs Globally - Yahoo Finance

Human Embryonic Stem Cell (hESC) Market Set to Record Exponential Growth by 2026 with Top Key Players- Astellas Institute of Regenerative Medicine…

Human Embryonic Stem Cell (hESC) Market research is an intelligence report with meticulous efforts undertaken to study the right and valuable information. The data which has been looked upon is done considering both, the existing top players and the upcoming competitors. Business strategies of the key players and the new entering market industries are studied in detail. Well explained SWOT analysis, revenue share and contact information are shared in this report analysis. It also provides market information in terms of development and its capacities.

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Chapter 1 Human Embryonic Stem Cell (hESC) Market Overview

Chapter 2 Global Economic Impact on Human Embryonic Stem Cell (hESC) Industry

Chapter 3 Global Human Embryonic Stem Cell (hESC) Market Competition by Manufacturers

Chapter 4 Global Production, Revenue (Value) by Region (2014-2020)

Chapter 5 Global Supply (Production), Consumption, Export, Import by Regions (2014-2020)

Chapter 6 Global Production, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global Human Embryonic Stem Cell (hESC) Market Forecast (2020-2027)

Chapter 13 Appendix

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Cryo-Cell Confirms Specimen Longevity of 23+ Years with Optimal CD34 Viability – PR Web

Cryopreservation Tanks

OLDSMAR, Fla. (PRWEB) March 13, 2020

Cryo-Cell Internationals announcement is concurrent with the most recent research regarding the lifespan of stored cord blood performed by Dr. Hal Boxmeyer and colleagues, which determined sample viability of 23.5 years and suggested possible, indefinite length of storage time for cryogenically preserved cells under proper conditions. Cryo-Cell International marks the first family cord blood bank to release results concerning specimen viability for this length of time.

Since cord blood banking has only been in existence for 30 years, these findings indicate that specimen longevity nearly spans the lifetime of the industry. Research points to the idea that other cryogenically preserved cells remain undiminished by time, as long as cells are preserved at optimal storage temperature, where cellular activity is known to halt. Cryo-Cell International, Inc., stands as the only private use cord blood bank in the U.S. to receive the Foundation for the Accreditation for Cellular Therapy (FACT) accreditation, which addresses all quality aspects of cord blood collection, processing, testing, banking, selection and release of specimens.

Todd Schuesler, Director of Cryo-Cell Internationals laboratory and cryopreservation facility, noted, Cryo-Cell is accredited by FACT, AABB, and ISO13485, making us one of the most accredited cord blood banks in the U.S. These accreditations are only awarded to organizations with exceptional quality systems and acute commitment to customer care. Its our employees who make the difference; for many, it is personal, based on previous or current experiences with diseases that can or will potentially be treated with stem cells. Having access to cord blood and cord tissue for the treatment of diseases developed much later in life will prove to be invaluable as evolving research continues to reveal potential uses.

These are simply amazing results that validates our belief that, if properly processed and maintained at the proper temperature, cryogenically preserved cord blood stem cells can provide regenerative benefits for at least the babys lifetime and likely for generations thereafter, said David Portnoy, Cryo-Cell Internationals Chairman and Co-CEO. Currently, cord blood stem cells have been FDA-approved for standard treatment in nearly 80 diseases. Numerous clinical trials are underway to explore the use of umbilical stem cells in the treatment of various degenerative conditions, including autism and cerebral palsy.

About Cryo-Cell International, Inc.

Founded in 1989, Cryo-Cell International, Inc. is the world's first private cord blood bank. More than 500,000 parents from 87 countries trust Cryo-Cell to preserve their family members' stem cells. Cryo-Cell's mission is to provide clients with state-of-the-art stem cell cryopreservation services and support the advancement of regenerative medicine. Cryo-Cell operates in a facility that is FDA registered, cGMP-/cGTP-compliant, and is licensed in all states requiring licensure. Besides being AABB accredited as a cord blood facility, Cryo-Cell is also the first U.S. (for private use only) cord blood bank to receive FACT accreditation for adhering to the most stringent cord blood quality standards set by any internationally recognized, independent accrediting organization. In addition, Cryo-Cell is ISO 9001:2008 certified by BSI, an internationally recognized, quality assessment organization. Cryo-Cell is a publicly-traded company, OTCQB:CCEL. For more information, please visit http://www.cryo-cell.com. For a complete list of references, visit http://www.cryo-cell.com/references.

Forward-Looking Statement Statements wherein the terms "believes", "intends", "projects", "anticipates", "expects", and similar expressions as used are intended to reflect "forward-looking statements" of the Company. The information contained herein is subject to various risks, uncertainties and other factors that could cause actual results to differ materially from the results anticipated in such forward-looking statements or paragraphs, many of which are outside the control of the Company, which include future medical and research developments.The Company disclaims any obligations to subsequently revise any forward-looking statements to reflect events or circumstances after the date of such statements.

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Lupus can be difficult to diagnose because its symptoms mimic those of other illnesses – PhillyVoice.com

When you are not feeling well, all you want to do is pinpoint why and get proper treatment. For patients with lupus, however, the journey to a correct diagnosis can be especially frustrating.

An estimated 1.5 million people in the U.S. are living with lupus, an autoimmune disease that causes inflammation and tissue damage in the joints, skin, brain, lungs, kidneys and blood vessels.

Dr. Roberto Caricchio, director of the Temple Lupus Program at Temple University Hospital, told PhillyVoice that the biggest challenge in diagnosing lupus is connecting the patient with someone who understands the different ways lupus can affect the body.

So how does it affect the body? He explained, "We have a wonderful immune system able to distinguish ourselves from bacteria, viruses, etc. With an autoimmune disease like lupus, however, the body is not able to tell the difference and attacks itself.

"It is like having a chronic infection but against yourself. Why is that? We don't know. There is some genetic predisposition. There are about 150 abnormal genes, but not all lupus patients have them. We know that women are more prone 90% of people with lupus are women and that the sun can be a trigger, but we only have bits and pieces of the puzzle, not the whole picture," he said.

"We are actually making more progress treating the disease than understanding it."

Women of African American, Hispanic, Asian and Native American descents are at the most risk for lupus. Environmental factors, viruses and infections can also be triggers. Epigenetics, which are changes in chromosomes, is another possible cause.

Lupus is often referred to as the great imitator because its symptoms mimic those of many other illnesses. Lupus symptoms also tend to wax and wane, further complicating the diagnosis process.

According to the Lupus Foundation of America, it takes an average of nearly six years for people with lupus to be diagnosed after they first start to experience symptoms. In a survey of lupus patients, 63% had received incorrect diagnoses at first, and more than half had to see four or more different specialists before the right diagnosis was found.

There are four different types of lupus: systemic lupus erythematosus, cutaneous lupus, neonatal lupus and drug-induced lupus.

"Systemic Lupus Erythematosus can manifest into a diverse range of symptoms and only a lupus expert can recognize the patterns of manifestation," Caricchio said.

Symptoms can include joint pain and swelling, skin rash, fever, fatigue and weight loss. Some of these are constitutional symptoms, meaning that they are not disease specific, complicating the diagnosis process.

Caricchio added that many lupus patients may only have kidney problems or shortness of breath from fluid on their lungs. Others will just have fluid on the heart called pericardial effusion.

One telltale sign of lupus is a facial rash resembling butterfly wings that spread across both cheeks.

Systemic Lupus Erythematosus, orSLE, affects many parts of the body, while cutaneous lupus causes rashes or lesions on the skin, most often after being exposed to sunlight.

Neonatal lupus is a form of lupus that occurs when a mother with SLE passes autoantibodies to her baby, which are mistakenly attacked by the child's immune system. Normally any skin, liver and blood problems resolve within six months. However, if the child develops a congenital heart block, a pacemaker might be needed.

To diagnose lupus, one's doctor will most likely order blood tests for certain auto-antibodies, as well as skin and kidney biopsies, depending on the symptoms.

The tests shouldn't be ordered until the clinical evaluation points to lupus,Caricchio explained,because some people will test positive without actually having the disease.

Treatment of lupus tends to be multidisciplinary because it depends on the parts of the body affected. Since there is currently no cure, the goal is to prevent or treat flare up of symptoms, prevent or reduce damage to affected joints or organs, reduce swelling and pain and suppress an overactive immune system.

Common medicationsprescribed to treat lupus include corticosteroids, antimalarials, biologics, immunosuppressive drugs like cyclophosphamide andnon-steroidal, anti-inflammatory drugs or NSAIDS.

Most lupus patients should take the malaria medication hydroxychloroquine,Caricchio said,because it can ease joint pain and swelling and skin rash.

"Level of treatment changes depending on spectrum of severity," he said. "We are very aggressive when needed, and when a flare stops, then we taper off the medicine."

Asked if eating a special diet can help ease symptom, he said, "There is no lupus diet. There is only a healthy and a not healthy diet."

Living with lupus means a person also needs to be aware of the increased risks for other health problems, like cardiovascular disease, kidney disease and stroke.

Lupus can accelerate the process of atherosclerosis, the build up of plaque along the lining of arterial walls. Some people with lupus experience inflammation in the heart (myocarditis and endocarditis) or the surrounding membranes.

Having lupus can also increase your risk of infection, cancer,pregnancy complications andbone tissue death calledavascular necrosis

"I can't emphasize enough that lupus patients should be vaccinated for protection against infections before they are immunosuppressed," Caricchio said, adding that vaccines should not be given during a flare and that recombinant vaccines are the safest for them.

There are also consequences of treatment because of increased risk of side effects like diabetes and osteoporosis mostly from the prednisone, a corticosteroid. Caricchio said lupus patients should be monitored for these side effects and treated immediately to minimize complications.

Research is ongoing not only to identify better treatment options but also understand the disease's progression.

The Lupus Foundation of Americarecent foundthat more frequent flares is associated with worse patient hospitalization, and higher medical bills.

Another study points to arthritis, skin lesions and low, white blood cell counts as early signs of lupus. The researchers also found a strong auto-antibody presence in almost 90% of lupus patients.

Stem cell therapy is one of the newest treatments for lupus. Right now though it is still in clinical trials. Caricchio said that there are several new lupus treatments under investigation.

"I have been following lupus since the late 80s, and there has never been a better time for lupus clinical trials," he said. "Within two to three years, I anticipate that we will have more treatments to offer."

He also added, "Over the last 20 years, we have learned to better use what treatments we already have. Better experience with the medicines has helped us achieve many more remissions so patients can live longer, better quality lives."

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