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HIV positive man ‘cured’ of the virus after a stem cell transplant

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HIV positive man ‘cured’ of the virus after a stem cell transplant.

The unidentified ‘London patient’ has been free of the virus for 18 months without viral-suppressing treatment after a stem cell transplant to treat his cancer, thus becoming the second person ever to be cured of the virus.

‘Berlin Patient’ Timothy Ray Brown was successfully cured of the HIV virus 12 years ago.

Experts hailed the news as a ‘milestone’ in the fight against HIV.

Aside from HIV, both men were in the advanced stages of cancer – the Berlin patient with leukemia, the London patient with Hodgkin’s lymphoma.

Timothy Ray Brown, the Berlin patient, had both – his cancer returned and he developed graft-versus-host disease, putting him in a coma and requiring a second bone marrow transplant.

The London patient had one: he suffered graft-versus-host disease.

Against the odds, they both survived, HIV-free.
Some believe that, ironically, graft-versus-host disease might have helped both of them to further obliterate their HIV.

But there is no way to control or replicate that safely.
Dr Anthony Fauci, head of the HIV/AIDS division at the National Institutes of Health, told DailyMail.com the report was ‘elegant, important work’ that ‘fortifies the proof of concept’ shown in the Berlin patient: that donor cells from someone who is HIV-resistant can wipe out a recipient’s HIV if they survive the transplant.

‘But it’s completely non-practical from the standpoint for the broad array of people who want to get cured,’ Dr Fauci added.

‘If I have Hodgkin’s disease or myeloid leukemia that’s going to kill me anyway, and I need to have a stem cell transplant, and I also happen to have HIV, then this is very interesting.

‘But this is not applicable to the millions of people who don’t need a stem cell transplant.’

Dr Janet Siliciano of Johns Hopkins, one of the leading researchers in how HIV hides in the body, agreed that the findings have limited impact in a real-world sense.

But it shows that the first time wasn’t a fluke – as so many feared when attempts to replicate the Berlin patient’s treatment failed time and time again.
‘I think it’s very exciting,’ Dr Siliciano

‘Now we know that it’s not just the Berlin patient. Now we know that n=2.’
The case, published online on Monday by the journal Nature, involved researchers at four UK universities: UCL, Imperial, Oxford and Cambridge. It will be presented on Tuesday at an HIV conference in Seattle.

The patient was diagnosed with HIV in 2003. He started taking anti-retroviral therapy (or, ART, which are virus-suppressing drugs) to control the infection in 2012. Ever since 1996, when ART was discovered, it has been recommended as immediate treatment post-diagnosis. The researchers do not elaborate on why the London patient went nine years before starting on ART.

He developed Hodgkin lymphoma that year. In 2016, he agreed to a stem cell transplant to treat the cancer.

As with any other patient in his rather unique situation, his doctors hoped they could strike the perfect balance: find a donor with HIV-resistant genes that could wipe out his cancer and virus in one fell swoop.

Most of us carry the gene CCR5. It is very unhelpful in many ways. It hampers our ability to survive strokes and recover from them, according to recent research. It is also the gene that HIV targets and uses as its access point to enter the immune system.

A minority of people in the world carry a mutation of CCR5, which prevents it from expressing, essentially blocking the gene altogether.

As a result, they are naturally resistant to HIV, earning them the name ‘elite controllers’ – because they naturally ‘control’ the virus as if they were on virus-suppressing medication.

As with the Berlin patient, the London patient’s doctors found a donor with a CCR5 mutation.

About 1 percent of people descended from northern Europeans have inherited the mutation from both parents and are immune to most HIV. The donor had this double copy of the mutation.

That was ‘an improbable event,’ said lead researcher Ravindra Gupta of University College London. ‘That’s why this has not been observed more frequently.’

Tests not only found no trace of R5 virus (the type associated with CCR5), but also no trace of X4 virus, a type of HIV associated with another gene entirely.
Eighteen months later without drugs, he remains HIV-free.

 

 

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