March 24, 2019

Treating lymphoma with HIV-resistant stem cells "cures" another patient

06 March 2019, 06:10 | Silvia Roy

London patient’ might be 2nd to be cured of HIV 10+ years after ‘Berlin patient

London patient’ might be 2nd to be cured of HIV 10+ years after ‘Berlin patient

The stem cells used for the transplant came from a donor who had a relatively rare genetic mutation that confers resistance to HIV. People with two copies of the Δ32 mutation of CCR5 gene are resistant to HIV-1 infection. The new patient, treated by doctors in Europe and nicknamed "the London patient" for anonymity, mirrors a similar case from over a decade ago, which scientists have spent years trying to replicate.

"The so-called London Patient has now been off ART for 19 months with no viral rebound which is impressive, but I would still be closely monitoring his viral load", Sharon Lewin, IAS Governing Council Member and Co-Chair of the Towards an HIV Cure initiative, said.

In the new case, now dubbed the "London patient", the anonymous male also received a stem cell treatment from a donor with the same CCR5 gene mutation, this time while being treated for Hodgkin's lymphoma.

Back in 2009, doctors published a report in the New England Journal of Medicine detailing the case of the "Berlin patient" - an HIV-positive man who'd received a stem cell transplant to treat his leukemia.

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Nonetheless, future research into how this HIV receptor functions could bring us a lot closer to an eventual cure for HIV, which now infects around 37 million people worldwide.

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. 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.

HIV experts said the importance of a second "cure" can't be underestimated.

Only one other patient who has been cured from HIV is Timothy Ray Brown from Berlin. Brown's experience suggested that HIV might one day be curable; it fuelled various efforts by researchers and institutions to focus on HIV cure research.

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Fauci sees the report of the London patient as being less about the possible benefits of bone marrow transplants in treating or even curing HIV, and more about the need to focus HIV research on CCR5.

The man is being called "the London patient", in part because his case is similar to the first known case of a functional cure of HIV - in an American man, Timothy Brown, who became known as the Berlin patient when he underwent similar treatment in Germany in 2007 which also cleared his HIV. In both cases, the donors' stem cells immediately began to attack the patients' immune cells. Bone marrow from a CCR5 negative donor was also given to the "London Patient". Four years later, doctors gave him a bone marrow transplant, and luckily for him, his donor for the marrow had natural immunity to HIV.

He has now been in remission for 18 months after his antiretroviral drugs were discontinued, researchers said. 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. Worldwide, an estimated 36.9 million people were living with HIV at the end of 2017.

However, now that science has determined that the earlier Berlin patient's HIV cure wasn't merely a unusual fluke, it could open up the doors to new gene-level treatments for the disease.

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