A second person experienced sustained remission from HIV-1; meaning that, effectively, a person with HIV has been cured of the viral infection.
The case – published Tuesday in the Nature journal – comes over 10 years after a somewhat similar (and first) case that involved the “Berlin patient” (later identified as Timothy Ray Brown, 52, who now lives in Palm Springs, California). Both patients were treated with stem cell transplants from donors who carried a rare genetic mutation, known as CCR5-delta 32, that made them resistant to HIV.
The new case, with the patient now referred to as the “London patient”, has been in remission for 18 months since he stopped taking antiretroviral drugs. A male resident of the UK was diagnosed with HIV infection in 2003 and began antiretroviral therapy in 2012. Later, he was diagnosed with advanced Hodgkin’s lymphoma. After chemotherapy, he underwent a stem cell transplant in 2016 and remained on antiretroviral therapy for 16 months.
The London patient quit taking anti-HIV drugs in September 2017. He has now been in remission for 18 months, and regular testing has confirmed that his HIV viral load remains undetectable. This makes him the first patient since Berlin patient/Brown to remain virus-free for more than a year after stopping.
In both cases, the stem cell transplant procedure worked about as well, with the transplant destroying the cancer without harmful side effects. The transplanted immune cells, now resistant to HIV, seem to have fully replaced the vulnerable cells.
Thus far, most people with the HIV-resistant mutation, called delta 32, are of Northern European descent. IciStem maintains a database of about 22,000 such donors.
The International AIDS Society (IAS) welcomed the announcement.
“This is the second reported case of prolonged remission off antiretroviral therapy (ART) post bone marrow transplantation from a CCR5 negative donor,” IAS President Anton Pozniak said. “Although it is not a viable large-scale strategy for a cure, it does represent a critical moment in the search for an HIV cure. These new findings reaffirm our belief that there exists a proof of concept that HIV is curable. The hope is that this will eventually lead to a safe, cost-effective and easy strategy to achieve these results using gene technology or antibody techniques.”
Mark Dybul, co-chair of the Towards an HIV Cure initiative, said: “Despite the great success of ART, there remains a high need for a cure for HIV, especially in low-income settings. This case is as important as it is exciting. There is still more to discover.”
UNAIDS seconded the sentiment, saying that it is greatly encouraged by the news that an HIV-positive man has been functionally cured of HIV.
“To find a cure for HIV is the ultimate dream,” said Michel Sidibé, Executive Director of UNAIDS. “Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure. However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.”
Stem cell transplants are highly complex, intensive and costly procedures with substantial side-effects and are not a viable way of treating large numbers of people living with HIV. However, the results do offer a greater insight for researchers working on HIV cure strategies and highlight the continuing importance of investing in scientific research and innovation.
In 2017, there were 36.9 million people living with HIV and 1.8 million people became newly infected with the virus. In the same year, almost one million people died of AIDS-related illnesses and 21.7 million people had access to treatment.