London patient cured of HIV, says case report

Wednesday, 11 March, 2020

London patient cured of HIV, says case report

A case report published in The Lancet HIV has detailed the second claimed incidence of a patient cured of HIV. The London-based patient received a stem cell transplant from donors with the HIV-resistant gene CCR5 — 30 months after stopping anti-retroviral therapy, no active viral infection was detected in the patient’s blood, cerebrospinal fluid, semen, intestinal tissue or lymphoid tissue.

In 2011, a patient based in Berlin (the ‘Berlin patient’) was the first person to be reported cured of HIV three and a half years after undergoing similar treatment, which included total-body irradiation, two rounds of stem cell transplantation from a donor carrying an HIV-resistant gene, followed by chemotherapy.

The patient in this study (the ‘London patient’) received a stem cell transplant and a reduced-intensity chemotherapy drug regimen, without whole-body irradiation.

“We propose that these results represent the second ever case of a patient to be cured of HIV,” said study lead author Professor Ravindra Kumar Gupta from the University of Cambridge, UK.

“Our findings show that the success of stem cell transplantation as a cure for HIV, first reported nine years ago in the Berlin patient, can be replicated.

“It is important to note that this curative treatment is high risk, and only used as a last resort for patients with HIV who also have life-threatening haematological malignancies. Therefore, this is not a treatment that would be offered widely to patients with HIV who are on successful antiretroviral treatment.

While most HIV patients can manage the virus with current treatment options and have the possibility of living a long and healthy life, experimental research of this kind can provide insight into how a more widely applicable cure might be developed in the future.

Compared with the treatment received by the Berlin patient, the authors highlight that the London case study represents a step towards a less-intensive treatment approach, showing that long-term remission of HIV can be achieved using reduced-intensity drug regimens, with one stem cell transplant (rather than two) and without total-body irradiation.

The authors noted that the London patient will need continued monitoring for re-emergence of the virus.

Speculating on what their results might mean for the future development of HIV treatment, study co-author Dr Dimitra Peppa from the University of Oxford said, “Gene editing using the CCR5 has received a lot of attention recently. The London and Berlin patient[s] are examples of using the CCR5 gene in curative therapies outside of gene editing.

“There are still many ethical and technical barriers — eg, gene editing, efficiency and robust safety data — to overcome before any approach using CCR5 gene editing can be considered as a scalable cure strategy for HIV.”

Writing in a linked comment, Professor Sharon R Lewin from the University of Melbourne (who was not involved in the study) said, “The finding of no intact virus can be reassuring for a patient who might face significant anxiety and uncertainty about whether and when viral rebound off ART might occur, which in other settings has been completely unpredictable.

“Given the large number of cells sampled here and the absence of any intact virus, is the London patient truly cured? The additional data provided in this follow-up case report is certainly encouraging but unfortunately in the end, only time will tell.”

Image credit: © Kalinin

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