After the “Berlin patient” also the “Londoner” free of HIV

WWhen something is done a second time, it’s usually not a big deal. Repetitions are not records and are therefore rather boring. It is different with the recurrence case, which doctors now present in the specialist journal “The Lancet”: they have managed to free the world’s second HIV-positive person from the virus.

According to the team led by Ravindra Kumar Gupta from Cambridge University, no active HI viruses were found in his blood 30 months after the therapy. The so-called London patient is therefore considered cured.

AIDS has been considered incurable for decades. For people infected with the HI virus, better and better medications became available over time, and AIDS turned from a death sentence to a serious but treatable chronic illness. The life expectancy of those affected also increased. But there was no cure for her, the virus could not be removed from her body. They had to – and still have to – take medication for a lifetime and always expect the pathogen to multiply again. The joy was all the greater when experimental therapy was successful at the Berlin Charité in 2007: Doctors had carried out a special stem cell therapy on HIV-positive patient Timothy Ray Brown, which resulted in the virus no longer being detectable in his body. The case was spectacular. However, there is a catch to the therapy: it is not suitable for everyone infected with HIV because it is extremely risky.

It was carried out with Timothy Ray Brown because, after testing positive for HIV for more than ten years and having been on antiretroviral therapy for a long time, he also developed acute myeloid leukemia. Chemotherapy for this blood cancer did not work. So the Berlin hematologist Gero Hütter arranged a stem cell transplant with bone marrow cells that carry the so-called CCR5 gene. It makes them resistant to the HI virus. Before that, however, the Berlin patient had to undergo radiation treatment in which most of his bone marrow cells were to be killed.

Gero Hütter’s hope was that if the graft succeeded with the healthy cells that were resistant to the HI virus, Brown’s immune system would be equipped with these cells in the future. Viruses that were still in the body would no longer penetrate these cells and could weaken the immune system. If the experimental treatment was successful, the patient would be protected against HI viruses from now on.

The risky attempt worked. Timothy R. Brown has stopped taking antiviral medication in 2007 and is considered cured. Since then, six other HIV-positive people have been treated according to this pattern. However, some of them relapsed. The London patient was the second to receive this therapy and everything went well with him. In 2012, he was diagnosed with Hodgkin’s lymphoma in addition to his HIV infection. Immunotherapy and chemotherapy failed, in 2016 a bone marrow donor was found that not only fit, but also carried the CCR5 gene in duplicate.

No active virus particles were found in his blood two and a half years after stem cell therapy. Study lead Ravindar Kumar Gupta says: “This is the second case of a patient who has been cured of HIV.” He emphasizes that “it was able to replicate the HIV cure that first occurred in the Berlin patient nine years ago”.

Samples of blood, brain and seminal fluid, stomach and intestinal tissue and lymphatic fluid have been repeatedly taken from patients in London. At the moment, all laboratory values ​​look very good, the cells are healthy, virus particles have not been found. However, the doctors emphasize that the London patient will continue to be closely monitored. As great as this success is, it could possibly be more of an intermediate step: a bone marrow transplant is only possible for very few patients; they not only have to be HIV-positive, but also have a pre-existing haematological disease.

The Berlin and London patients are special medical cases. Something can also be learned from this for the treatment of other HIV-infected people. Because obviously the introduction of the bone marrow cells with the CCR5 gene is the decisive step of the therapy. In the distant future, when all ethical and technical hurdles have been overcome, the bone marrow cells can be genetically surgically modified so that they carry the CCR5 resistance.

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