'London patient' becomes HIV-free after transplant

Pearl Mccarthy
March 7, 2019

Here's what to know about the landmark case.

Brown, who had been living in Berlin, has since moved to the United States and, according to HIV experts, is still HIV-free.

Later that year, he was diagnosed with advanced Hodgkin's Lymphoma, a deadly cancer.

He was then treated with radiation and chemotherapy in order to erase his immune system so it could be reconstituted with donated stem cells taken from a donor who was immune to HIV.

But replacing immune cells with those that do not have the CCR5 receptor appears to be key in preventing HIV from rebounding after the treatment.

AIDS researchers have known about the this CCR5 mutation for years and have tried to think of ways to exploit it as a treatment for HIV. The title is similar to the first known case of a cured HIV-positive patient. 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. "Is that a cure?"

"I never thought that there would be a cure during my lifetime", he said. "It can't grow, it can't replicate, it can't spread - it can't cause any problems". Almost 1 million people die every year from HIV-related causes.

He has now been in remission for 18 months after his antiretroviral drugs were discontinued, researchers said.

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Could the patient's HIV come back?

Exact match donors would have to be found in the tiny proportion of people - a lot of them of northern European descent - who have the CCR5 mutation. But the virus is clever and comes in another form that can use a different, side entrance into cells through another receptor called CXCR4.

"While it is too early to say with certainty that our patient is now cured of HIV, and doctors will continue to monitor his condition, the apparent success of haematopoietic stem cell transplantation offers hope in the search for a long-awaited cure for HIV/AIDS", added Professor Eduardo Olavarria, from Imperial College London.

That didn't happen with the London patient. People who have two mutated copies of the CCR5 allele are resistant to the HIV-1 virus strain that uses this receptor, as the virus can not enter host cells.

That means the London patient may have HIV remaining that can use CXCR4 to infect cells, giving the virus a way to start flourishing again.

Bone marrow transplant is a high-risk, life-threatening procedure. The cancer proved resistant to chemotherapy and the patient required a bone marrow transplant. The first, the Berlin Patient, also received a stem cell transplant from a donor with two of the CCR5 alleles, but to treat leukaemia.

The London patient is said to have undergone a similar treatment to Mr Brown by receiving bone marrow stem cells from a donor. Finding ways to treat people infected with HIV with some infusions of mutated CCR5 cells that block infection seems to make more sense now. Scientists are following 38 people with HIV who've received transplants.

Still, Fauci is hopeful that such approaches will eventually be available for HIV patients. "So while it's truly aspirational, I wouldn't say it's out of the realm of possibility".

Timothy Brown also known as The Berlin Patient.

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