Man cleared of HIV virus infection after stem cell transplant

Grant Boone
March 5, 2019

Doctors said a London man with HIV has become the second known adult in the world to be apparently cleared of the infection since the global epidemic began decades ago, giving hope for a potential cure for AIDS.

This comes 12 years after the first success case of Timothy Ray Brown - a US-based man treated in Germany's Berlin, a feat researchers failed to duplicate.

Nearly three years after receiving bone marrow stem cells from a donor with a rare genetic mutation that resists HIV infection - and more than 18 months after coming off antiretroviral drugs - highly sensitive tests still show no trace of the man's previous HIV infection.

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).

This, as reported by the New York Times, is what was discovered when a London patient was examined for traces of the virus after an operation.

Prof Graham Cooke, NIHR research professor and reader in infectious diseases from Imperial College London, said the results were "encouraging". Numerous attempts to replicate the procedure have not been successful until now, with the latest case dubbed that of the "London patient".

In the meantime, he said the focus needed to be on diagnosing HIV promptly and starting patients on life-long combination antiretroviral therapy, known as cART. 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. The patient, who chose to be anonymous, was cured after a stem cell transplant.

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This is obviously mind-blowing news, but there's a caveat: most experts agree that it can't be a solution for many HIV patients.

However, bone-marrow transplants are traditionally risky and painful.

PARIS- A second person is in sustained remission from HIV-1, the virus that causes AIDS, after ceasing treatment and is likely cured, researchers were set to announce at a medical conference Tuesday.

In some of the past transplant failures, the donor did not have a mutated CCR5, but the conditioning regimen seemed to have significantly reduced the "reservoirs" of cells in the recipient that have latent HIV infections, invisible to the immune system.

The London patient is 36 on this list. "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". Another one, number 19 on the list and referred to as the "Düsseldorf patient", has been off anti-HIV drugs for four months. "There are similarities with the Berlin Patient case, but there are also differences".

One possibility, said Deeks and others, is to develop gene-therapy approaches to knock out CCR5 on immune cells or their predecessor stem cells. "I never thought that there would be a cure during my lifetime".

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