A man from Düsseldorf, now 53 years old and who suffered from leukemia, has been in remission for four years with the virus
Science has confirmed the third case of HIV cure in the world after a stem cell transplant. After the berlin patient (2008) and the London patient (2019), now comes the Düsseldorf patient. Although the process by which they have been cured of HIV is complex and cannot be applied to all people with the infection, this new medical milestone shows that researchers are getting closer to curing HIV.
‘Nature Medicine’ just posted a study of the IciStem consortium, coordinated by the AIDS Research Institute IrsiCaixa (in turn, promoted by the La Caixa Foundation, as well as by the Department of Health of Catalonia) and by the University Medical Center of Utrecht (Netherlands). This is the case of a man who HIV antiretroviral treatment was withdrawn on a supervised basis after undergoing a stem cell transplant to treat a myeloid leukemia. Four years later, the virus has not reappeared.
Research shows the absence of viral particles and of immune response against the virus in the patient’s body despite receiving no treatment for four years, evidences that allow the scientific team to consider that the case of the Düsseldorf patient is a new case of cure.
“We carry nine years studying these exceptional cases in which, thanks to a therapeutic strategy, the virus is completely eliminated from the body. We want to understand each step of the healing process in detail to be able to design strategies that are replicable for the entire population,” he explains. Javier Martinez-Picado, ICREA researcher at IrsiCaixa, co-director of IciStem, and co-author of the article.
The Düsseldorf patient
In 2008, a medical team in Düsseldorf, Germany, diagnosed HIV infection in a person who would later be known as the Düsseldorf patient. After diagnosis, the patient started antiretroviral treatment, which allowed him to control the infection and reduce the amount of virus to undetectable levels in the blood. Four years later, in 2012, he suffered a leukemia, that is, a cancer in the cells of the immune system. So they had to do a stem cell transplant.
In these unique cases, a stem cell donor is sought who has a mutation called CCR5 Delta 32 (CCR5d32). This genetic alteration prevents the entry of the virus into the target cells of HIV (or, what is the same, in the cells through which it is transmitted). expands the virus in the body): the T-CD4 lymphocytes. In this way, it makes infection difficult. “That all these factors coincide is very complicated, only 1% of the population has this mutation and, furthermore, it is necessary for the donor to be a blood-compatible donor to avoid rejection of the transplant”, remarks Maria Salgado, researcher at IrsiCaixa and co-author of the study.
more than five years later of the transplant, and having gone through two relapses of leukemia and various complications, the patient It stabilized. From there, the research team agreed withdraw antiretroviral treatment against HIV. To this day, the Düsseldorf patient has 53 years and it’s in good health. “When he stopped taking the treatment, we followed him up for 44 months and we did not detect any trace of the virus in the patient’s blood or tissues,” says Salgado. “We have not seen no immune response characteristic of a viral outbreak. Your defenses are not activated against HIV because They don’t have to defend themselves against the virus,” Add. The scientific team affirms that the person has been cured of the HIV infection.
stem cell transplant
The three patients in the story cured of HIV so far shared one characteristic: they had a hematological cancer. The first, the Berlin patient, was Timothy Brown (he ended up revealing his identity), who died in 2020, but not from HIV, but from the terminal cancer he suffered: a leukemia (like the Düsseldorf patient). The second, the London patient (who served, 11 years later, to confirm the case of Timothy Brown), had a Hodgkin lymphoma. All three patients received a stem cell transplant that cured them of HIV. In addition, the cells that they transplanted to all three had that CCR5 Delta 32 (CCR5d32) mutation. However, the doctors clarify, stem cell transplantation is an intervention high risk and is only recommended for patients with hematological problems serious. The risk of death is between 40% and 50% chance. That is why it is not the solution to cure HIV.
Researchers are designing therapies to be able to do this at long term. The gene therapy (which consists of extracting cells, treating them in the laboratory and reimplanting them in the patient) is a possible future cure for this disease, but it is still in progress. preclinical phase. The researchers emphasize that the patient, in no case, has to interrupt antiretroviral treatment on your own, but you should always do it on your own. medical indication.