Published: Wed, March 06, 2019
Health Care | By Cedric Leonard

IAS statement on "London Patient" in HIV remission after transplant

IAS statement on

In 2008, German doctors at Charité Medical University in Berlin published a paper on a scenario nearly identical to that of the London Patient - a man who had a persistent form of blood cancer was given a bone marrow transplant paired with HIV-resistant stem cells. Specifically, the donor had a mutation in a gene that codes for a protein called CCR5, which HIV uses as a "port" to get inside cells.

The "London Patient" is only the second person known to have shaken off the HIV virus during a 40-year AIDS epidemic that has infected 70 million people and killed half of them.

Gupta went on to tell the outlet that the patient was "in remission" and "functionally cured"; however, "It's too early to say he's cured" completely, said the doctor.

Some 37 million people worldwide are now infected with HIV and the AIDS pandemic has killed about 35 million people worldwide since it began in the 1980s.

In a statement to The Times, the London patient said it was "surreal" to think that he could be cured of both cancer and HIV. However, because HIV remained undetectable, he is still considered clinically cured of his infection, according to his doctors. The therapy responsible has worked on only one other person who is considered to be "cured" of HIV: Timothy Ray Brown, who still does not show signs of the virus in his body after more than 10 years.

For this reason, he's often described as being the first patient "cured" of HIV, although technically that's incorrect, since remission and cures are not the same thing (as sometimes remissions are not complete, if the viral load stages a resurgence). After two bone marrow transplants, Brown was considered cured of his HIV-1 infection. Scientific research into the complex virus has in recent years led to the development of drug combinations that can keep it at bay in most patients. "We can't detect anything", said Ravindra Gupta, a professor and HIV biologist who co-led a team of doctors treating the man.

The man, who has been HIV positive since at least 2003, now appears to have had the virus driven from his system by a very special genetic mutation present in the stem cells of a donor.

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"It shows the Berlin patient was not just a one-off, that this is a rational approach in limited circumstances", Daniel Kuritzkes, chief of infectious diseases at Brigham and Women's Hospital (who was not involved in the study), told the paper. Interestingly, the donor's stem cells had a mutation named CCR5 delta 32.

"HIV Is Cured In 2nd Patient, Doctors Report, Such great news for so many". Bone marrow from a CCR5 negative donor was also given to the "London Patient".

16 months after the stem-cell transplant, September 2017, the man went off his antiretroviral drugs for HIV.

"Two factors are likely at play - the new bone marrow is resistant to HIV and also the new bone marrow is actively eliminating any HIV-infected cells through something called graft versus host disease".

Current HIV therapies are really effective, meaning people with the virus can live long and healthy lives.

Although the finding is exciting, it is not offering up a new treatment for the millions of people around the world living with HIV.

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