Thursday, 21 March, 2019

London patient becomes second known man cleared of HIV

Has a second person with HIV been cured? Breakthrough: A Second HIV Patient Has Gone Into 'Long-Term' Remission
Celia Hoffman | 08 March, 2019, 19:11

Though the London patient is choosing not to disclose his name for the time being, he described the experience as "surreal" and "overwhelming" in an email to Mandavilli at The New York Times.

The new report shows that doctors don't have to use as intense a treatment regime as the Berlin patient underwent in order to achieve success.

Fast forward to 2016 when the London patient received a bone marrow transplant from a donor with the same mutation. This week Brown celebrated 12 years free of HIV at a community cure workshop prior to the conference.

Like Timothy Ray Brown, the first person to have been cured of HIV, the London patient required a bone marrow transplant to treat cancer. In both successful cases, patients were given bone marrow transplants as a treatment for cancer when they stopped responding to chemotherapy. In September 2017, 16 months after the stem cell transplant, the "London patient" went off antiretroviral drugs and has remained HIV-free.

However, current treatments must be administered throughout a patient's life, and millions worldwide lack access to a source of consistent therapy.

A few key differences exist between Brown's case and that of the London patient, however. The interaction may have helped destroy some of the HIV infection in the patients, Gupta says.

The new case "shows the cure of Timothy Brown was not a fluke and can be recreated", Dr. Keith Jerome, Fred Hutchinson Cancer Research Center in Seattle, told the AP. He was treated with anti-retroviral drugs until about 18 months ago.

But McKnight cautioned that this won't necessarily lead to a treatment for all HIV individuals.

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The fact that this second patient has gone into remission can give researchers more confidence they're on the right path, Kiem said.

Gupta said he hoped to expand research on the stem-cell transplant technique to focus on communities in Africa, where the HIV-beating mutation does not naturally occur. A stem cell transplant allows the body to be repopulated with healthy blood cells - and a new immune system.

Although Brown almost died after he was given strong immunosuppressive drugs and was put into a coma, the "London patient" did not come that close; he suffered from Hodgkin's lymphoma and received a similar bone-marrow transplant to Brown's, but the immunosuppressive drugs he received were gentler.

CCR5 is the most commonly used receptor by HIV-1 - the virus strain of HIV that dominates around the world - to enter cells. In both cases, the donors' stem cells immediately began to attack the patients' immune cells.

Dr. David Hardy chairs the board of directors for the HIV Medicine Association. "The question was, was his case a fluke?"

If this second patient is "cured", Hardy said, it would "certainly support" ongoing efforts to develop CCR5-directed therapies. "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", said Gupta from University College London (UCL), the study's lead author "Finding a way to eliminate the virus entirely is an urgent global priority, but is particularly hard because the virus integrates into the white blood cells of its host", he said in a statement. "[This] doesn't change things for the average person with HIV right now", the Ragon Institute's Bruce Walker, who was not involved in the study, told Kate Sheridan at STAT News.

Much more work remains ahead, but this second remission is "very exciting", Kiem said. They typically require knocking down the body's immune system to prevent it turning on the foreign cells.

So it's possible, Hardy said, that graft-versus-host disease is partly responsible for wiping out the "remnants" of their HIV.

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