Second HIV patient reaches remission

Original author: Chris Lane
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The second patient with HIV-1 has persistent remission after discontinuation of treatment. This is stated in a report by scientists from University College and Imperial College London.

The medical history described in the scientific journal Nature was published 10 years after the first such clinical case, known as the “Berlin patient”. Colleagues from Cambridge and Oxford Universities participated in the publication.

In both cases, the patient was transplanted with stem cells from donors with a mutation of the CCR5 gene that is immune to HIV.

In a new study, the patient is in remission 18 months after discontinuation of antiretroviral therapy (ART). The authors of the report believe that it is too early to speak with confidence about complete healing. They will continue to monitor the patient's condition.

“Currently, the only way to treat HIV is to suppress the virus with medicines that have to be taken for life, which causes certain difficulties in developing countries,” said lead author of the study, Professor Ravindra Gupta. “The search for a method that will destroy the virus once and for all is a paramount task of an international scale that requires immediate solution. Finding it is extremely difficult, as the virus enters the carrier’s white blood cells. ”

Almost 37 million people live with HIV worldwide, but only 59% get ART. Also of concern is the increasing resistance of HIV to drugs. About 1 million people die every year for reasons one way or another related to HIV.

The report describes a male patient from the UK who chose to remain anonymous. He was diagnosed with HIV in 2003 and has been receiving antiretroviral therapy since 2012.

Later in 2012, he was diagnosed with advanced Hodgkin's lymphoma. In addition to chemotherapy, in 2016 he underwent an operation to transplant a hematopoietic stem cell from a donor with two copies of the CCR5-Δ32 gene.

CCR5 is the most commonly used HIV-1 receptor. People with two copies of the CCR5 mutation are immune to the HIV-1 receptor that uses it, since the virus cannot enter the cell.

Chemotherapy can successfully fight HIV, as it kills dividing cells. Replacing immune cells with those that do not have the CCR5 receptor may be key to preventing the recurrence of HIV symptoms after treatment.

The transplant took place without serious complications, but with some side effects, including a mild reaction "transplant against the host" - a complication in transplantation, when donor immune cells attack the recipient's immune cells.

After the transplant, the patient received antiretroviral therapy for another 16 months, after which the joint decision of the patient and doctors stopped the treatment to find out whether the patient with HIV really has remission.

Analyzes showed a constant absence of the concentration of the virus in the patient’s blood. He is in remission for 18 months after discontinuation of treatment (35 months after transplantation). Its immune cells do not produce the CCR5 receptor.

This is the second recorded case of persistent remission without ART. In the first “Berlin patient”, stem cells from a donor with a CCR5-Δ32 mutation were also transplanted, but only for the treatment of leukemia. The main difference between the “Berlin patient” is that he had two transplant operations and total body irradiation, while the “London patient” underwent only one transplant and less intensive chemotherapy.

Both patients experienced a mild graft versus host reaction, which could also play a role in the death of HIV-infected cells.

“Having managed to achieve remission in the second patient thanks to a similar approach, we showed that the“ Berlin patient ”was not an anomaly, namely, the chosen treatment method saved two people from HIV,” said Professor Gupta.

Scientists warn that this method cannot be accepted as a standard for the treatment of HIV due to the toxic effects of chemotherapy, but gives hope for a new treatment strategy that will finally defeat HIV.

“We are continuing the study to understand if we can disable this receptor in people with HIV, which is quite possible with gene therapy,” said Professor Gupta.

“The treatment we used is different from what the“ Berlin patient ”underwent because we did not use radiation therapy. Its success indicates the importance of developing a new strategy based on the suppression of CCR5 gene expression, ”said study co-author Dr. Ian Gabriel.

“It is too early to claim that our patient has completely recovered from HIV. Doctors will continue to monitor his condition. The apparent success of the hematopoietic stem cell transplant allows us to hope that a long-awaited cure for HIV / AIDS will be found, ”said Professor Eduardo Olavarria.

Photo Credit: C. Goldsmith

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