Posted on Mar 07, 2019, 9 p.m.
A patient in the UK has become HIV undetectable following stem cell transplant, this is only the second case of its kind, involving the University of College London, Cambridge University, Imperial College London, and Oxford University, as published in the journal Nature.
The patient was being treated for cancer in London, and has now been in remission from HIV for 18 months, and is no longer taking antiretroviral therapy HIV drugs, regular testing has confirmed the viral load has remained undetectable since then; but it was noted that it is too soon to say the patient is cured.
This approach is not practical for treating most patients with HIV, but it may one day lead to finding a cure. The unnamed male London patient was diagnosed with HIV in 2003 then advanced Hodgkin’s lymphoma in 2012. Chemotherapy was used to treat the cancer, and stem cells were implanted from a donor resistant to HIV, which has lead to his current condition of being in remission from both HIV and cancer.
This is the second time a patient treated in a similar manner has become in remission from HIV. Another patient who received a bone marrow transplant from a donor with natural immunity to the HIV virus in Berlin 10 years ago also ended up in remission from HIV. Timothy Brown was given two transplants and total body irradiation for leukaemia, and is said to be the first person to beat Aids/HIV.
Achieving remission in a second patient using a similar approach in London has shown the original treatment in Berlin was not just an anomaly or one-off, and this treatment approach really was what eliminated the HIV in these two individuals.
This is indeed an exciting finding after 10 years of not being able to replicate the original case, but it doesn’t offer up a new treatment for the upwards of 37 million around the globe living with HIV, as this aggressive therapy was primarily used to treat both patient’s cancer, however it does offer a starting point.
Current therapies are said to be effective; meaning they help people infected with the virus live longer and healthier lives, but they are still not a cure, drugs will always be needed. These cases are still significant as they can help experts develop new ways to fight the virus and find a cure, especially since a new drug resistant form of HIV is a growing concern.
Gaining better understandings of how the body can naturally resist infection offers hope of a cure, even if it still remains just out of grasp; this success of stem cell transplantation provides renewed hoped that strategies may be developed to tackle the virus as expanding remission to those affected disproportionately is important.
This treatment is not appropriate as being standard due to the high toxicity of chemotherapy used to treat the cancer, and much longer follow up is needed to ensure the virus does not re-emerge at a later state.
CCR5 receptor is most commonly used by the HIV-1 virus to enter cells. A small amount of people who are resistant to HIV have two mutated copies of this receptor; meaning the virus can’t penetrate the cells it would normally infect. When the patient received the donor transplants with this specific genetic mutation it also made him resistant to HIV as well. However reservoirs of cells carrying the virus still remain in the body in resting states for many years, and it is possible they may re-emerge later on. According to researchers it may be possible to use gene therapy to target CCR5 receptors in those with HIV now that it is known Berlin was not a one-off anomaly.
Dr. Andrew Freedman of Cardiff University says “this is very interesting and potentially significant, but a much longer follow up is required to ensure there is no re-emergence. While this treatment is not practical to treat everyone reports such as these may lead to a cure. Meanwhile focus needs to be on diagnosing HIV patients promptly and starting them on the lifelong cART treatment to help prevent further spread of the virus and provide the opportunity for those infected to live near normal life expectancy.”
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