March 24, 2019

London HIV patient gives more hope of finding a cure

07 March 2019, 09:44 | Silvia Roy

A second person has experienced sustained remission from HIV-1 according to a case study to be published Tuesday in the journal Nature

A second person has experienced sustained remission from HIV-1 according to a case study to be published Tuesday in the journal Nature

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.

The milestone came about three years after the man received bone marrow stem cells from an HIV-resistant donor and about a year and a half after coming off antiretroviral drugs. Brown had received two similar transplants to treat his leukemia; his donors were intentionally chosen because they not only matched him, but they also harbored genetic mutations that made their cells almost impervious to HIV infection.

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.

The therapy works by effectively replacing the blood cells of an infected person with that of someone who is immune to HIV through a genetic mutation which prevents to virus attaching to cells.

Although the patient has been in remission for 18 months, the authors of the British study published on Tuesday in the science journal Nature cautioned it was too early to say he had been cured.

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"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", Gupta explained.

After being diagnosed with Hodgkin's Lymphoma, a rare blood cancer, the London patient received a bone marrow transplant in 2016.

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. Indeed, 16 months later, his virus remains at below detectable levels, and his immune cells all contain the HIV-fighting CCR5 mutation. "We need to understand if we could knock out this (CCR5) receptor in people with HIV, which may be possible with gene therapy", he said.

The transplant went relatively smoothly, Gupta said, but there were some side effects, including the patient suffering a period of "graft-versus-host" disease - a condition in which donor 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 transplant changed the London patient's immune system, giving him the donor's mutation and HIV resistance.

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"I did not want to be the only person in the world cured of HIV", Brown wrote in a medical journal in 2015, explaining why he made a decision to reveal his identity. HIV-1 remission following CCR5Δ32/Δ32 haematopoietic stem cell transplantation.

Such transplants are risky and have failed in other patients.

The case report is carried out by researchers at University College London (UCL) and Imperial College London, together with teams at the University of Cambridge and the University of Oxford.

The research team is presenting the findings today at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

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