United Kingdom patient 'free' of HIV after stem cell treatment

Henrietta Brewer
March 7, 2019

Nearly three years after receiving bone marrow stem cells from a donor with a rare genetic mutation that resistsHIV infection - and more than 18 months after he came off antiretroviral drugs - highly sensitive tests still show no trace of the man's previous HIV infection. Ten years ago, Timothy Brown - dubbed the "Berlin patient" - became the first person to be effectively cured of HIV using a similar method.

Then in 2017, Gupta took the London patient off of the anti-HIV drugs to see if the transplant had worked as it had in Brown's case: to push the HIV into remission.

Professor Eduardo Olavarria, from Imperial College London, said: "While it is too premature to say with certainty that our patient is now cured of HIV, he is clearly in a long-term remission". The transplant destroyed the cancer without harmful side effects, while the transplanted immune cells, which are now resistant to H.I.V., seem to have fully replaced his vulnerable cells, according to the paper. "I think it is important to reaffirm that this is real and it can be done", Gupta said.

"Finding a way to eliminate the virus entirely is an urgent global priority, but is particularly hard because the virus integrates into the white blood cells of its host".

The first, the Berlin Patient, also received a stem cell transplant from a donor with two CCR5 alleles, but to treat leukaemia.

Doctors found a donor with a gene mutation that confers natural resistance to HIV. But HIV drugs have become so effective that many people carrying this infection have a normal lifespan if they take these medications for a lifetime.

During the treatment the patient underwent "graft-versus-host" disease, where the donor's immune cells attack the recipient's immune cells. "H.I.V. uses the protein to enter those cells but can not latch on to the mutated version".

The man has chosen to remain anonymous, with scientists referring to him as "the London patient".

CCR5 is the most commonly used receptor by HIV-1, the most common and most harmful type of HIV.

Around 100,000 people in Britain are living with HIV and the team is now looking into whether it is possible to simply knock out the receptor through gene therapy. After standard treatments failed, they gave the patient a stem-cell transplant - essentially killing off his old immune system and giving him a new one. Notable differences were that the Berlin Patient was given two transplants and underwent total body irradiation, while the United Kingdom patient received just one transplant and less intensive chemotherapy. The therapy responsible has worked on only one other person who is considered to be "cured" of HIV: Timothy Ray Brown, who still does not show signs of the virus in his body after more than 10 years.

That was "an improbable event", said lead researcher Ravindra Gupta of University College London.

The team is presenting the findings at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, US this week.

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