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LONDON (CNN) – A second person has experienced prolonged remission of HIV-1, according to a case study published Tuesday in the journal Nature. Some scientists believe that the "London patient" has been cured of the viral infection, which affects nearly 37 million people worldwide.
Another group of researchers said Wednesday that a third patient might also have eliminated an HIV infection. Evidence from a "patient from Düsseldorf" was presented at the Conference on Retroviruses and Opportunistic Infections in Seattle, alongside the London Patient Report. This third case study has not been published in a peer-reviewed journal.
Highlights on HIV / AIDS
The published case report of the London patient comes more than 10 years after the first case, called "Berlin patient". Both patients were treated with stem cell transplants from donors carrying a rare genetic mutation, called CCR5-delta 32. This made them resistant to HIV. The London patient has been in remission for 18 months since he stopped taking antiretrovirals.
"By realizing remission in a second patient using a similar approach, we showed that the Berlin patient was not an abnormality and that it was really the treatment that eliminated HIV in these two people," Ravindra said. Gupta, lead author of the study. and Professor at the Infection and Immunity Division of University College London.
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Gupta added that the method used is not suitable for all patients but offers hope for new treatment strategies, including gene therapies. He and his colleagues will continue to monitor this man's situation because it is too early to say that he has been cured of HIV.
Nearly one million people die each year from HIV-related causes. HIV treatment includes drugs that suppress the virus, called antiretroviral therapy, that people living with HIV need to take for life.
Another patient in remission
The patient from Gupta, a UK resident who prefers to remain anonymous, was diagnosed with HIV in 2003 and started 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.
To check if he was really in HIV-1 remission, the London patient discontinued his usual antiretroviral therapy. He has been in remission for 18 months and regular tests have confirmed that his viral load in HIV remains undetectable.
Similarly, Timothy Ray Brown, the Berlin patient, was living with HIV and was systematically using antiretroviral therapy when he was diagnosed with a different disease, acute myeloid leukemia. After two bone marrow transplants, Brown was considered cured of his HIV-1 infection. Traces of HIV were seen in Brown's blood a few years after stopping antiretroviral therapy. However, as HIV remains undetectable, he is still considered clinically cured of his infection, according to his doctors.
Despite various attempts by scientists using the same approach, Brown remained the only person cured of HIV until the new London patient.
Dr. Gero Hütter, who treated the patient from Berlin and is currently medical director of the Cellex Collection Center in Dresden, Germany, said in an email that the treatment used for the London patient was "comparable" to that of he was the pioneer.
"They used a reduced intensive conditioning regime but I think it had no influence on the results," he said. A conditioning regimen, which can include chemotherapy and whole body radiotherapy, prepares the patient to accept stem cell therapy, such as a bone marrow transplant, by making room for new ones. stem cells.
The important point here is that it was assumed that the Berlin patient might have something special, but now, "we know that this is reproducible," said Hütter, who was not involved in treating the patient from London. He thinks the translation of the gene therapy approach could work – although it has not been proven yet – and if so, it could become an option for a large number of people. HIV patients.
Since the Berlin patient, "cure" and not just treatment has become a topic of HIV research, said Hütter: "This new case supports the idea of seeking a cure for HIV."
Dr. Björn Jensen from the University of Düsseldorf presented the case of the third patient, who remains HIV-free after stopping his medication for three and a half months.
Like the London patient, the patient from Düsseldorf has undergone mild cancer chemotherapy, no radiation and a single stem cell transplant as part of a blood cancer treatment and has achieved HIV remission.
The patient was examined by internationally renowned researchers who used the most sensitive techniques available and who detected only traces of HIV genetic material, according to a statement from IciStem, a collaborative project to study the HIV cure potential in patients requiring stem cell transplantation for blood. diseases. The researchers reported no rebound of HIV in the patient.
Evidence from patients in London and Düsseldorf, who both participate in a program at IciStem, suggests that the technique is more than an anomaly.
Other patients are part of the IciStem program, which has identified more than 22,000 donors with the rare gene defect CCR5-delta 32; it is possible that other patients will achieve HIV remission.
"We still have a lot of work to do"
Dr. Sharon Lewin, Director of the Peter Doherty Institute for Infection and Immunity and Professor of Medicine at the University of Melbourne, said the long-term remission seen in London patients was "exciting."
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"Ten years after the success of the Berlin patient report, this new case confirms that bone marrow transplant from a negative CCR5 donor can eliminate the residual virus and prevent any trace of virus from rebounding," said Lewin. who was not involved in the process. new case study. "Two factors are probably at play: the new bone marrow is resistant to HIV and, in addition, the new bone marrow actively removes HIV-infected cells."
Graham Cooke, professor of infectious diseases at Imperial College London, said in a statement to the Science Media Center that the new study is "encouraging."
"If we can better understand why the procedure works in some patients and not in others, we will be closer to our ultimate goal of curing HIV," said Cooke, who did not participate in the study. Case study. "At the moment, the procedure is still too risky for patients who are doing well, because a daily treatment for HIV tablets usually helps to maintain the patient's health over the long term."
Dr. Timothy Henrich, an associate professor of medicine and physician researcher in the Department of Medicine at the University of California at San Francisco, also noted that treating London's patient "is not an evolutionary strategy without dangerous or economically viable to induce HIV remission "Its use is reserved for those who need the transplant for other reasons, not just for HIV, said Henrich, who did not participate to the new case study.
"Many strategies are currently being implemented," Henrich said. "Some of them are directly related to the Berlin patient and are working with a transplant: for example, a gene modification treatment."
Scientists are also studying immunomodulatory therapies.
"I'm optimistic because I'm a scientist and vice versa," Henrich said. "I have hope. I think it is quite possible to find an evolutionary treatment that is safe and can be applied to the vast majority of people living with HIV, but we still have a lot of work to do. "
Meera Senthilingam from CNN contributed to this report.
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