The Face of a Medical BreakthroughSubmitted by lk429 on Tue, 10/03/2020 - 11:29
Professor Ravindra (Ravi) Gupta joined Homerton as a Professorial Fellow in October 2019, in the wake of mass media interest. As the scientist responsible for the second ever case of a patient being effectively ‘cured’ of the HIV virus, 12 years after the first, he was in demand as an interviewee everywhere from Radio 4’s Today programme to the New York Times. This March, as the individual so far known only as ‘the London patient’ reveals his identity as 40-year-old Adam Castillejo, Ravi is once again the face of a medical breakthrough that could have huge global implications – if it can be replicated.
Born in London to Indian parents, Ravi visited family in India regularly as a child, and has a lifelong fascination with travel.
“I became interested in diverse populations, and after taking medical electives all over the world I knew I wanted to do something international,” he explains.
While studying Medicine at Cambridge (his first College affiliation was to Downing), he also took courses from the Human, Social and Political Sciences Tripos, and was fascinated by the juxtaposition of medicine and politics. He then completed a Masters in Public Health at Harvard, before undertaking malaria research on the Thai/Burmese border. As a junior doctor he chose infectious diseases as his focus, working in Paris during the SARS outbreak, where he also encountered large numbers of HIV positive patients, predominantly from West Africa.
“I was interested in the HIV drugs that were becoming available in the developing world, and in how cells respond to viruses. I then did my PhD, in drug resistant HIV, at UCL.”
In 2015, while working as a Wellcome Trust Senior Fellow in infectious diseases at UCL, Ravi was approached by a London hospital with a potential case study. Since 2008, when Timothy Brown became the first ever patient with HIV to be free of the virus, scientists had been hoping to replicate the case. The circumstances of the London Patient appeared to meet the criteria.
In Timothy Brown’s case, a bone marrow transplant intended primarily to treat his leukaemia had rid him of the HIV virus. The London Patient had both HIV and Hodgkin’s lymphoma, for which a transplant was the only chance of a cure. As in the previous case, the best donor match available had a rare natural mutation to the CCR5 gene, which results in a natural resistance to HIV. The question was whether this resistance would effectively cure the patient of HIV, as a side effect to the lymphoma treatment.
A bone marrow transplant is a risky and unpleasant procedure. “It’s a complete clear out of the patient’s own cells, which would be very extreme in a healthy patient,” Ravi explains. “The London Patient had a lot of infections immediately afterwards, and there’s always the threat of Graft versus Host disease, in which the transplanted cells from the donor try to fight the recipient’s body.”
Given that, if it is diagnosed early enough, HIV patients in the developed world with access to antiretroviral treatment have generally good outcomes, the question is whether such an extreme treatment would be worth it.
“Can we identify people who aren’t doing well on the drugs as candidates for a milder form of stem cell therapy? People who start treatment late often have damaged immunity, and HIV is obviously still a huge threat to people who don’t have access to treatment, especially in developing countries.”
Now Professor of Clinical Microbiology and Wellcome Trust Senior Fellow in Clinical Science at Cambridge, Ravi’s primary research focus is on the increasing problem of drug resistant HIV, and the potential development of alternative treatments. His work had a significant impact on changing 2018 WHO guidelines on which first line drugs should be used to treat HIV positive individuals. While a cure that is applicable to all patients may not be an imminent prospect, the success of the London Patient is a hugely significant breakthrough.
Having moved to Cambridge last summer with his wife, a trainee surgeon at Addenbrooke’s, and their three small daughters, Ravi’s College base is now Homerton.
“I didn’t really think I’d be able to have the whole College experience and be part of a College community, given the intensity of my lab work and the fact that I’m also treating patients, as well as overseeing academic microbiologists” he says. “But because Homerton is so near to Addenbrooke’s I’m able to be here relatively often for lunch in the Great Hall or a coffee in the combination room. It’s great to have that break from the hospital environment, and it’s such a fascinating mix of people to get to know.”