WHEN presenting his work at the global gene-editing summit, He Jiankui noted the medical seriousness of HIV infection, saying he was proud of his efforts to use CRISPR to create infants that may be resistant to the virus.
Is HIV so dangerous that it warrants such a drastic step? Certainly, the toll of HIV infection is high in some parts of the world. But advances in antiviral medicines over the past decade mean that people with HIV who have access to good healthcare now have a close-to-normal lifespan. The HIV-positive fathers who took part in the trial are reported to have had their virus under control, suggesting these men had access to such drugs.
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Gene editing doesn’t offer HIV-positive men their only chance to have unaffected children. Current treatments for HIV push the level of the virus down so low that a person’s partner or future offspring aren’t at risk of infection. Furthermore, the experiment used a “washing” technique to remove any HIV from the sperm before it was used for IVF, meaning that even without drug treatment, no virus could have made it into the embryos.
If the aim was to protect the children from acquiring HIV as adults, a much simpler and safer medical intervention is already available to some: taking some of the antivirals used for treatment as a preventative. In certain Western cities, this “PrEP” strategy is contributing to tumbling rates of infection among gay men.
“The choice of gene was about the stigma that surrounds HIV rather than fulfilling a medical need”
It can be argued it would be easier not to have to take such medicines. If we reach a stage where editing embryos becomes routine, could the modifications made by He be worth including? It seems unlikely, because mutating the CCR5 gene as he did doesn’t give complete protection against all strains of HIV. People would still need to take preventative steps such as using condoms or PrEP.
He’s choice of gene was all about the stigma that still surrounds HIV rather than fulfilling any real medical need, says Deborah Gold of the UK’s National AIDS Trust.
This article appeared in print under the headline “Why was HIV the first target of gene editing?”
