A Second Patient in Long-Term Remission From HIV

Henrietta Brewer
March 8, 2019

Reuters reports that the man, whose identity has not been revealed, has tested negative for the virus nearly three years after he received a bone marrow transplant from a donor with an HIV-resistant genetic mutation.

"By achieving remission in a second patient using a similar approach we have shown that the Berlin patient was..." The donated cells, with their ability to fight HIV, have now taken root in Brown's body. As such, this procedure is unlikely to become a realistic treatment for HIV in the future-especially given that the antiretroviral drugs prescribed for the infection have been shown to be extremely effective.

According to experts, Brown has been living in the United States, and is still free of the disease.

Steven Deeks, an HIV researcher at UCSF, says the results could also boost cure efforts to cripple CCR5 "without the need for heroic interventions such as in the Berlin and London cases". The London patient stopped anti-HIV drugs more than a year ago (in September of 2017) and has had no sign of the virus since. Both the Berlin and London patients had this complication, which may have played a role in the loss of HIV-infected cells, Gupta said. Scientific research into the complex virus has led to the development of drug combinations that can keep it at bay in most patients. This particular intervention is likely to be effective in only a small fraction of the 37 million people worldwide who now harbor the virus in their bodies. In 2007, he received a rare form of bone marrow transplant involving haematopoietic stem cells to treat his leukaemia. Their donors were selected for their natural immunity to HIV infection, having a variant of the gene for the CCR5 receptor that does not allow the virus to penetrate immune cells.

The man, who has been dubbed the "London patient," is the second person to receive the treatment.

Brown sat in the front row, stood for a round of applause and shook hands with lead researcher Ravindra Gupta of University College London after Gupta presented details on the London patient.

The researchers caution that the approach is not appropriate as a standard HIV treatment due to the toxicity of chemotherapy, but it offers hope for new treatment strategies that might eliminate HIV altogether. Brown had developed leukemia and needed two bone-marrow transplants. While this appears to be the second longest adult HIV remission yet observed, they acknowledge that "it is premature to conclude that this patient has been cured".

Unlike for Brown, radiotherapy wasn't required and the London patient experienced far less severe consequences than Brown, but Gupta believes the chemotherapy used against the lymphoma was an essential part of its success, temporarily destroying fast-dividing cells so replacement could occur.

"At the moment, the only way to treat HIV is with medications that suppress the virus, which people need to take for their entire lives", said Gupta.

Blood cells of an infected person are replaced by someone who is immune to HIV through a genetic mutation which stops the virus attaching to cells.

"While we fully understand that stem cell transplantation is not a practical way of curing large numbers of people, we can learn a tremendous amount from these cases" said amfAR Chief Executive Officer Kevin Robert Frost.

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