New research demonstrates a case of long-term HIV remission in a patient who had a procedure to replace their bone marrow cells.
“It shows it’s not impossible – it’s just very difficult – to remove HIV from the body,” said virologist Björn-Erik Jensen who lead the study published Monday in the Nature journal.
HIV, or the human immunodeficiency virus is a virus that damages the immune system. It causes acquired immunodeficiency syndrome, or AIDS, which includes a number of potentially life-threatening infections.
As of 2021, an estimated 38.4 million people around the world were living with HIV, according to UNAIDS.
Approximately 1.2 million people in the U.S. have HIV and about 13% “don’t know it and need testing,” according to the U.S. government.
An absence of viral rebound was observed related to “a 53-year-old male who was carefully monitored for more than nine years,” after the procedure is strong evidence for HIV-1 cure, said the study.
In 2013, Jensen also lead the team at Düsseldorf University Hospital in Germany who treated the patient known as the “Düsseldorf patient”, who was at the time taking antiretroviral therapy (ART) to lower the virus to undetectable levels and had been diagnosed with acute myeloid leukemia. Although ART can keep HIV levels low and prevent transmission from person to person, stores of the virus can begin replicating when a person stops taking it.
Jensen’s team “destroyed the patient’s cancerous bone marrow cells and replaced them with stem cells from a donor with the CCR5Δ32/Δ32 mutation,” said an article in Nature. HIV uses the CCR5 cell-surface protein to enter immune cells and this mutation prevents it from being expressed on the cell surface, thus making “cells effectively resistant to the virus,” according to the article.
“A true cure would eliminate this reservoir, and this is what seems to have happened for the latest patient, whose name has not been released,” said Nature.
For years following the treatment, Jensen’s team took tissue and blood samples from the Düsseldorf patient. Although scientists continued to find immune cells that specifically reacted to HIV, suggesting a reservoir, as well as HIV DNA and RNA, they “never seemed to replicate.”
Jensen’s team also transplanted the patient’s “immune cells into mice engineered to have human-like immune systems,” where it also failed to replicate. Additionally, the patient stopped talking ART in 2018 and has remained HIV-free.
Timothy Ray Brown, also known as the “Berlin patient” was the first person to be cured of HIV with a stem cell treatment with the same mutation.
“In 2007, he had a bone marrow transplant, in which those cells were destroyed and replaced with stem cells from a healthy donor, to treat acute myeloid leukemia,” said Nature. “After the procedure, Brown was able to stop taking ART and remained HIV-free until his death in 2020.”
“He was such a symbol of hope for so many people living with HIV and an inspiration for those of us working toward a cure,” said Fred Hutchinson Cancer Research Center virologist Dr. Keith Jerome.
Adam Castillejo, the “London patient”, was also successfully treated with the same procedure in 2019, followed by a patient in New York last year. However, it may be too soon to determine if those patients are cured.
According to the Düsseldorf patient, the treatment and bone marrow transplant experience has been a “rocky road” and that he wants to support more research and fundraising. A presentation on the Düsseldorf, Berlin, London and New York patients was included during last year’s International AIDS Society “Pathways to an HIV cure: Research and advocacy priorities” conference.
“It is time to more firmly plant the need for an HIV cure on the policy agenda. While interventions that lead to a meaningful cure are at least decades away, we must begin planning for it sooner than later,” said Sharon Lewin, International AIDS Society Towards an HIV Cure Advisory Board Co-Chair. “Once available, we must ensure a cure can be successfully delivered to those countries most burdened by the disease, and delivery must come at speed.”
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