Breakthrough: A Second HIV Patient Has Gone Into 'Long-Term' Remission

Pearl Mccarthy
March 6, 2019

The announcement that a London man has become the second in the world to be "functionally cured" of HIV is a major advance in stem cell transplant therapy.

The man, who has been HIV positive since at least 2003, now appears to have had the virus driven from his system by a very special genetic mutation present in the stem cells of a donor.

"Coming 10 years after the successful report of the Berlin patient, this new case confirms that bone marrow transplantation from a CCR5-negative donor can eliminate residual virus and stop any traces of virus from rebounding".

Bone marrow transplants as an HIV cure is a treatment with harsh side effects, but The New York Times reported that scientists think giving patients similar HIV-resistant immune cells might do the trick.

"Whilst this type of treatment is clearly not practical for millions of people around the world living with HIV, reports such as this may help in the ultimate development of a cure", said Andrew Freedman, a reader in infectious diseases at Cardiff University in Wales.

Gupta and his team also emphasised that bone marrow transplant - a risky and painful procedure - is not a viable option for HIV treatment. Millions of people are HIV positive, ...

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). Specifically, the donor had a mutation in a gene that codes for a protein called CCR5, which HIV uses as a "port" to get inside cells.

Calling the London patient "cured" is tricky, Gupta said, because there is no standard definition for how long someone must remain free of virus and off treatment drugs. HIV is at its most unsafe when it is actively replicating, furiously producing as many copies of itself as possible so it can penetrate immune cells and spread infection.

In 2016 the patient underwent haematopoietic stem cell transplant and remained on anti-viral drugs for more than a year afterwards.

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The London, U.K. patient has not been identified.

Does this mean HIV has been cured?

Acute myeloid leukemia patient Timothy Brown, who became known as the "Berlin patient", was treated aggressively more than a decade ago in an HIV-curing approach that hasn't been successfully repeated until Ravindra Gupta and colleagues showed the effectiveness of a less aggressive form of treatment.

CCR5 is on the surface of white blood cells, and HIV uses it to enter a cell.

As with cancer, chemotherapy can be effective against HIV as it kills cells that are dividing.

The "London patient" told the Times, "I feel a sense of responsibility to help the doctors understand how it happened so they can develop the science", adding that when he was apprised he might be cured it felt "surreal" and "overwhelming". Then, in 2012 the unidentified patient was diagnosed with a cancer, Hodgkin lymphoma.

CCR5 is the most commonly used receptor by HIV-1. At one point during his treatment, the Berlin patient almost died and had to be placed in an induced coma.

But in the case of the London patient, the treatment worked.

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