HIV remission achieved in second patient ever

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A second individual has achieved sustained remission from HIV-1 after ceasing antiretroviral treatment, according to researchers from University College London (UK).

The case, reported in Nature, comes 10 years after the first instance of HIV remission known as the ‘Berlin Patient’. The ‘Berlin patient’ underwent two hematopoietic stem cell transplants from donors carrying a genetic mutation preventing the expression of CCR5 – a HIV receptor – and received total body irradiation with each treatment. The procedures were for the treatment of acute myeloid leukemia, however, they also achieved HIV remission.

The individual in the latest study is a UK-based male patient who has had a HIV infection since 2003 and has been on antiretrovirals from 2012. Later in 2012 the patient was diagnosed with Hodgkin’s lymphoma, leading to chemotherapy and a hematopoietic stem cell transplant from a donor with two CCR5 Δ32 alleles. Mild graft-versus-host disease was detected.

Sixteen months after the stem cell transplant the clinical team ceased antiretroviral therapy to assess the status of the HIV infection. The researchers report the patient has been in HIV remission for 18 months since ceasing antiretroviral therapy, with regular testing revealing undetectable viral loads. However, it is too early to say whether the individual has been cured and the team continue monitor them.

“At the moment the only way to treat HIV is with medications that suppress the virus, which people need to take for their entire lives, posing a particular challenge in developing countries,” commented lead author, Ravindra Gupta (University College London).

“Finding a way to eliminate the virus entirely is an urgent global priority but is particularly difficult because the virus integrates into the white blood cells of its host.”

This is the second individual ever to be documented to have achieved sustained HIV remission without antiretroviral therapy, and this patient underwent a less aggressive and less toxic procedure than the original Berlin patient. Although this approach is not appropriate as a standard-of-care owing to the toxicity of chemotherapy, it could offer hope for new HIV treatment strategies based on CCR5 expression.

Gupta explained: “By achieving remission in a second patient using a similar approach, we have shown that the Berlin Patient was not an anomaly, and that it really was the treatment approaches that eliminated HIV in these two people. Continuing our research, we need to understand if we could knock out this receptor in people with HIV, which may be possible with gene therapy.”

Co-author, Ian Gabriel (Imperial College Healthcare NHS Trust, London, UK) concluded: “The treatment we used was different from that used on the Berlin Patient, because it did not involve radiotherapy. Its effectiveness underlines the importance of developing new strategies based on preventing CCR5 expression.”

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Source: Gupta RK, Abdul-jawad S, McCoy LE et al. HIV-1 remission following CCr5Δ32/Δ32 haematopoietic stem-cell transplantation. Nature. 568, 244–248 (2019); www.cam.ac.uk/research/news/hiv-remission-achieved-in-second-patient

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