Two more HIV patients live without antiretrovirals

MONTREAL – Researchers here report that a man who had a history of some sort of living with HIV infection is now one of a handful of individuals in the world who have achieved functional cure for the disease that causes AIDS as well as a cure for acute leukemia.

The so-called “City of Hope patient” is a 66-year-old man who was first diagnosed with a specific disease of AIDS in 1988 and then diagnosed with acute leukemia in 2019, according to Jana Decker, MD, an infectious disease specialist. At City of Hope Medical Center in Duarte, California, speaking at the 2022 International AIDS Conference.

When a leukemia treatment required a stem cell transplant, Decker said, doctors sought a donor who possessed a homozygous CCR5 delta mutation that is resistant to HIV.

She said the patient received a blood stem cell transplant 3.5 years ago and stopped antiretroviral therapy for 17 months without any evidence of HIV replication in his body. “His acute leukemia remains in complete remission,” she said.

“This patient’s experience is unique from the three previous patients who were treated with stem cell transplants for their leukemia and then achieved remission from HIV,” Decker added. “At 63, he was the oldest person to have had a stem cell transplant with HIV and leukemia and then achieve remission from both conditions. He had been living with HIV longer than anyone else too — more than 31 years, before transplantation. “.

But the City of Hope patient wasn’t the only person discussed who had been off treatment for years without an HIV rebound discussed at the press conference.

Nuria Clement, PhD, a research scientist at the JM Miro Hospital Clinic at the University of Barcelona, ​​described in detail the “Barcelona patient” – a 59-year-old woman with sexually transmitted HIV who participated in a clinical trial in which different HIV strategies were attempted among severely infected individuals with HIV.

Although ART [antiretroviral therapy] Effective in suppressing viral replication, HIV persists in reservoirs and rebounds after stopping treatment,” she reported. However, a few patients, such as post-treatment controls, are able to maintain viral loads below the detection limits without antiretrovirals, a realistic model for functional HIV therapy.”

She stated that the Barcelona patient had kept her HIV under control after stopping treatment for more than 15 years. Clement said that at the time of her early infection, researchers were able to culture the virus from her blood. Her blood cells, which were supposed to be susceptible to the invasion of HIV, showed a natural resistance to the virus. Clement suggested that analysis of natural killer cells and CD8 T cells may show clues that could be used in future therapies. “Strategies able to expand these cells could help achieve functional HIV treatment,” she said.

“Treatment remains the holy grail of HIV research,” said Sharon Lewin, MD, president-elect of the International AIDS Society and professor of medicine at the University of Melbourne in Australia. “We have seen quite a few individual cures before, and the two cases presented here provide continued hope for people living with HIV and inspiration for the scientific community. The City of Hope patient is the oldest patient, and has been infected with HIV for a longer period before being infected. Current treatment .”

“Furthermore, we are now seeing progress on the huge challenge of finding an HIV reservoir biomarker – a really exciting development,” she said.

Commenting on her patient in the City of Hope, Decker said he appears to have benefited from the conditions surrounding stem cell transplantation: The donor cells contained the CCR5 delta32 mutation, and he received a less intense chemotherapy regimen developed by City of Hope for older and lesser adults. The suitability of patients makes them more likely to accept allogenic stem cells for the treatment of leukemias.

“This trial offers hope that some patients may not need extensive chemotherapy to receive a stem cell transplant in order to recover from HIV and leukemia,” Decker said. “This is important because because of advances in HIV treatment, people with HIV tend to live longer.”

These patients are among at least five individuals in the world who have achieved long-term recovery from HIV. Two other patients are the Berlin patient, the London patient, and the Brazilian patient.

The Berlin patient died after recurring leukemia. He has been HIV-free for about 15 years. The patient in London has been HIV-free for about 4 years since stopping antiretrovirals and is still doing well. A Brazilian patient had been in remission for more than 15 months before his viral load increased again in the summer of 2020.

Since 1981, the date when most people consider the beginning of the HIV epidemic, more than 50 million people have been infected with HIV worldwide.

  • Ed Sussman is a freelance medical writer based in Fort Pierce, Florida, USA.

Disclosures

The authors did not disclose any relevant relationships with industry.

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