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HIV patient cured after bone marrow transplant in rare case, research shows (WaPo)

28 February 2023

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Washington Post title: HIV patient cured after bone marrow transplant in rare case, research shows
By: Kelsey Ables
Date: 21 February 2023

“A man in Germany who had been diagnosed with HIV has been declared free of the virus after receiving HIV-resistant stem cells through a bone marrow transplant intended to treat leukemia. According to research published in the journal Nature Medicine on Monday, the man was monitored for more than nine years after the 2013 transplant, and there is now “strong evidence” that he has been cured.

The remission of HIV, which is usually considered lifelong, comes after a team at University Hospital Düsseldorf destroyed the patient’s cancerous cells and replaced them with donor cells that lack CCR5, the receptor that HIV particles use to infect cells. In 2018, the patient went off antiretroviral therapy (ART), a treatment that keeps HIV at manageable levels, and has remained free of HIV since, the paper said.

He is one of a small handful of people to receive such treatment effectively, including Timothy Ray Brown, who had a bone marrow transplant — also to treat leukemia — in Berlin in 2007, and Adam Castillejo, who was declared free of HIV in London in 2019.

While this treatment is unlikely to be used with non-cancer patients because of its high risks, the research offers further confirmation that HIV is not entirely incurable, as was once thought. It also offers hope for a future without daily medical treatment for those with HIV and underscores the potential for other research pursuing a cure.

Björn-Erik Jensen, the virologist who led the study at Düsseldorf University, said in a statement to Nature Medicine that the research “shows it’s not impossible — it’s just very difficult — to remove HIV from the body.”

Sharon Lewin, director of the Doherty Institute in Melbourne and president of the International AIDS Society, has known about the Düsseldorf patient for several years. Shesaid by phone that the research was “very reassuring,” noting that there have now been five patients who have been cured through this pathway.

“This is real, and it’s reproducible,” she said.

Lewin acknowledged that the approach is “not a reasonable strategy for 38million people living with HIV” globally but said it offers other avenues for more “scalable” research.

“The most important thing is that what we’ve learned from these studies is that if you make every cell resistant to HIV, the virus has got nowhere to go and eventually melts away,” she said.

There could be less invasive ways to create that resistance, such as genetherapy, which could make it possible to modify an HIV patient’s own cells to make them HIV-resistant. Lewin said there have been “some really big advances” in gene therapies over the past five years that might make this “highly feasible.”

The Düsseldorf patient marks the latest development in a disease that was once a deadly diagnosis. Thanks to breakthroughs in medicine, it has become a manageable condition for those with access to medication.

HIV damages immune cells and makes it difficult for one’s body to fight infection. But ART can slow HIV from multiplying and help an individual’s immune system get stronger. If those with HIV take the medication daily, they can decrease the viral load so that it is “undetectable” and not transmissible to sexual partners. However, HIV, when left untreated, can progress to AIDS.

From 1990 to 2019, deaths from HIV decreased by 86 percent. And average life expectancy after an HIV diagnosishas gone from one year in the 1980s, during the height of the AIDS epidemic, to nearnormal, according to the National Institutes of Health.

The research in the Nature paper is “inspiring and motivating,” Lewin said.

When someone is newly diagnosed with HIV, they often ask, “does that mean I’m on treatment forever?’” Lewin said. “As a doctor, I would say, ‘Yes, it does. But there’s a lot of work going on to find a cure.’”

“I think when people hear about cures, it has a very profound effect.” “


Sources:
https://www.washingtonpost.com/health/2023/02/21/duesseldorf-patient-hiv-cured-stem-cell/
and
Nature, 20 February 2023: In-depth virological and immunological characterization of HIV-1 cure after CCR5Δ32/Δ32 allogeneic hematopoietic stem cell transplantation

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