Wednesday, 20 March, 2019

London transplant doctors report a second person likely cured of HIV

Has a second person with HIV been cured? Breakthrough: A Second HIV Patient Has Gone Into 'Long-Term' Remission
Anna Jefferson | 10 March, 2019, 14:59

A London man has become the second person in "sustained remission" from the virus after receiving a stem cell transplant and undergoing chemotherapy, according to a new study in Nature. A transplant of bone marrow stem cells from a donor with that specific mutation has seemingly cured the man, known only as the "London patient", of his HIV infection.

Ten years after the first confirmed case of an HIV-infected person being rid of the deadly disease, a man known only as the "London patient" has shown no sign of the virus for almost 19 months, they reported in the journal Nature.

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.

CCR5 is the most commonly used receptor by HIV-1 but people who have two mutated copies of the CCR5 allele are resistant to the virus strain that uses this receptor. HIV-positive patients who require a transplant to survive cancer are also unfortunately rare, because they are often too sick to qualify for the hard procedure. Those patients could benefit if they can find a donor with the rare mutation in CCR5 that protects them from HIV re-infection.

Adalja noted that although the Berlin patient and the London patient received similar treatments, the Berlin patient's treatment was more intense - he received two bone-marrow transplants in addition to whole-body irradiation (radiation exposure to the whole body).

Although the finding is exciting, it is not offering up a new treatment for the millions of people around the world living with HIV.

While some commentators are calling this a "cure" for HIV, the scientists who performed the experiment say it's too soon to say that.

"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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The patient voluntarily stopped taking HIV drugs to see if the virus would come back.

A new drug-resistant form of HIV is also a growing concern. The transplanted stem cells can also produce immune cells that go on to attack their new host, a problem called graft vs. host disease.

Fast forward to 2016 when the London patient received a bone marrow transplant from a donor with the same mutation. He has been in remission ever since and is said to be the first person in the world to have been cured of HIV.

But a reservoir of cells carrying HIV can still remain in the body, in a resting state, for many years.

For both Brown and the London patient, the bone marrow transplant successfully killed cancerous cells while simultaneously providing cells immune to HIV.

"With regular testing, condoms, pre-exposure prophylaxis (PrEP) and the fact that people on effective HIV treatment can not pass on the virus, we have the ability to completely prevent new HIV transmissions".

And the remission was achieved with a less toxic regimen than Brown, the Berlin patient, received, the researchers said. Nearly one million people die annually from HIV-related causes. One possibility would be to alter the CCR5 gene, and thus compromise one of HIV's most prominent entry points into human cells. The unidentified individual has not needed antiretroviral drugs since September 2017. Both Brown and the London patient are testament to how effective such strategies in modifying CCR5 can be in thwarting HIV.

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