{"id":8983,"date":"2018-12-02T10:36:48","date_gmt":"2018-12-02T15:36:48","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8983"},"modified":"2018-12-06T15:37:09","modified_gmt":"2018-12-06T20:37:09","slug":"as-a-strategy-for-hiv-prevention-disabling-the-ccr5-gene-in-embryos-implanted-in-hiv-negative-mothers-makes-zero-sense","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/as-a-strategy-for-hiv-prevention-disabling-the-ccr5-gene-in-embryos-implanted-in-hiv-negative-mothers-makes-zero-sense\/2018\/12\/02\/","title":{"rendered":"As A Strategy for HIV Prevention, Disabling the CCR5 Gene in Embryos Implanted in HIV-Negative Mothers Makes Zero Sense"},"content":{"rendered":"<div id=\"attachment_8984\" style=\"width: 233px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/12\/nejmcibr1616057_f1.jpeg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8984\" class=\" wp-image-8984\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/12\/nejmcibr1616057_f1.jpeg\" alt=\"\" width=\"223\" height=\"396\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/12\/nejmcibr1616057_f1.jpeg 1800w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/12\/nejmcibr1616057_f1-169x300.jpeg 169w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/12\/nejmcibr1616057_f1-768x1364.jpeg 768w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/12\/nejmcibr1616057_f1-577x1024.jpeg 577w\" sizes=\"auto, (max-width: 223px) 100vw, 223px\" \/><\/a><p id=\"caption-attachment-8984\" class=\"wp-caption-text\">The CRISPR Way to Identify Proteins Essential to HIV-1 Infection. From N Engl J Med 2017; 376:1290-1291.<\/p><\/div>\n<p>One of the great joys of being an ID\/HIV specialist is looking back at how far we&#8217;ve come in HIV prevention and treatment since the beginning of the epidemic.<\/p>\n<p>Here are a bunch of things we know about HIV prevention,\u00a0listed roughly in order of when we learned them\u00a0&#8212; and forgive me if this is an oversimplification for this sophisticated readership:<\/p>\n<ul>\n<li>Condoms work very well in preventing HIV transmission.<\/li>\n<li>Taking a brief course of HIV therapy soon after exposure reduces the risk of HIV acquisition.<\/li>\n<li>Babies born to HIV-positive mothers do not contract HIV if the moms take suppressive HIV therapy.<\/li>\n<li>Male circumcision reduces the risk of these men acquiring HIV.<\/li>\n<li>People do not contract HIV from their HIV-positive partners if the person with HIV takes suppressive HIV therapy.<\/li>\n<li>People taking pre-exposure prophylaxis markedly reduce their risk for HIV acquisition.<\/li>\n<\/ul>\n<p>You&#8217;ll note that nowhere on this list is anything about preventing HIV in babies born to women who don&#8217;t have the virus to begin with &#8212; <em>because the babies are not at risk, even if the mother&#8217;s male sexual partner has HIV.<\/em><\/p>\n<p>Just typing that sentence felt a little strange, it&#8217;s so obvious. However, it seems that\u00a0He Jiankui may not understand this basic fact.<\/p>\n<p>He&#8217;s the scientist who startled the world <a href=\"https:\/\/youtu.be\/th0vnOmFltc\" target=\"_blank\" rel=\"noopener\">by releasing news<\/a> that he and his research team had used\u00a0CRISPR\u2013Cas9 genome-editing to alter the embryos of two babies. The editing disabled the CCR5 gene, which means the babies lack a key co-receptor that HIV uses to infect cells.<\/p>\n<p>However, as noted at 1:53 in the above-linked video, it&#8217;s the <em>father<\/em> who has HIV. Indeed, reports indicate that <a href=\"https:\/\/www.nytimes.com\/2018\/11\/28\/world\/asia\/gene-editing-babies-he-jiankui.html\" target=\"_blank\" rel=\"noopener\">eight serodiscordant couples have participated in his studies<\/a> &#8212; all with the fathers having HIV.<\/p>\n<p>I&#8217;ll let others with far greater knowledge of genetics, embryology, and medical ethics comment on just how reckless this experiment was &#8212; <a href=\"https:\/\/www.nytimes.com\/2018\/11\/27\/opinion\/genetically-edited-babies-china.html\" target=\"_blank\" rel=\"noopener\">here&#8217;s a good take<\/a> (there have been many).<\/p>\n<p>But from an HIV prevention perspective, it&#8217;s easy to judge &#8212; it makes <em>zero<\/em> sense to do this since the babies aren&#8217;t at risk of getting HIV to begin with. For them and their families, the genome-editing was all risk and no reward.<\/p>\n<p>Let&#8217;s hope the mothers understood this before they agreed to participate in this disturbing experiment.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>One of the great joys of being an ID\/HIV specialist is looking back at how far we&#8217;ve come in HIV prevention and treatment since the beginning of the epidemic. Here are a bunch of things we know about HIV prevention,\u00a0listed roughly in order of when we learned them\u00a0&#8212; and forgive me if this is an [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,9],"tags":[160,1154],"class_list":["post-8983","post","type-post","status-publish","format-standard","hentry","category-hiv","category-policy","tag-ccr5","tag-crispr-cas9"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8983","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=8983"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8983\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8983"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8983"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8983"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}