After receiving treatment in 2015, a guy in Germany had no detectable HIV in his body. Since the start of the AIDS pandemic, only six other patients have reached this milestone.
In the more than 40 years since the AIDS crisis started, only six other individuals have likely been cured of HIV, as this German man has done.
In October 2015, the German man, who wishes to remain unnamed, had a stem cell transplant as part of his treatment for acute myeloid leukemia, or AML. He is still in viral remission and has not seen a relapse after stopping his antiretroviral medication in September 2018. No viable HIV has been found in his body despite many ultra-sensitive testing.
Regarding his remission, the guy remarked in a statement that “a sick person has only one wish, a healthy person has many.”
Dr. Christian Gaebler, a physician-scientist at the Charité-Universitätsmedizin Berlin, is scheduled to discuss the case on Wednesday at the 25th International AIDS Conference in Munich. Investigators said that the case provided crucial lessons for HIV cure research.
The longer these HIV remissions continue without the use of HIV medicine, the more certain we may be that we are most likely seeing a situation in which all competent HIV has been destroyed, according to Gaebler.
Experts are keen to temper public enthusiasm with a warning, as they have with every other example of possible HIV cure: only a limited number of people will ever have access to the medicine that seems to have halted the virus in the seven individuals. All of them acquired HIV and subsequently developed blood cancer, for which they required stem cell transplants in order to get treatment.
The transplants, which were often from donors chosen for their immune cells—the cells that HIV targets—brought with them a rare, innate resistance to the virus and seemed to be responsible for eliminating all competent, or live, copies of the virus from the body.
Transplants using stem cells have a substantial risk of toxicity and death. Giving them to HIV-positive individuals would be unethical unless they were being treated for a different illness, such as blood cancer.
Because some of the cells that HIV infects are long-living immune cells that are inactive or enter one, HIV is very difficult to treat. The only immune cells that get standard antiretroviral therapy for HIV are those that are actively producing new viral copies, which is characteristic of infected cells. HIV remains unrecognized in resting cells as a result. These cells are collectively referred to as the viral reservoir.
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A reservoir cell has the ability to produce HIV at any time. For this reason, if an infected person stops taking their antiretrovirals, their viral levels usually increase again in a matter of weeks.
HIV may be cured in part because a stem cell transplant replaces a patient’s damaged immune system—caused by chemotherapy and sometimes radiation—with a healthy immune system from a donor.
Researchers discovered donors with uncommon, spontaneous abnormalities in both copies of a gene that produces a specific protein, called CCR5, on the surface of immune cells in five of the seven instances of a proven or likely HIV cure. To infect cells, the majority of HIV strains adhere to that protein. HIV cannot infect immune cells if CCR5 proteins are not functioning.
Because the German man’s donor only had one copy of the CCR5 gene, his immune cells most likely contained just half as much of the protein as usual. Furthermore, he only had one copy of the gene. These two genetic characteristics may have increased his chances of a recovery when combined, according to Gaebler.
Although around 1% of individuals with native northern European heritage have two copies of the faulty CCR5 gene, 16% of them have one copy.
In a media event this week, Dr. Sharon Lewin, head of the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia, said, “So the study suggests that we can broaden the donor pool for these kinds of cases.”
Interestingly, a donor with two healthy copies of the CCR5 gene was linked to a guy receiving treatment in Geneva whose potential HIV cure was revealed last year. Thus, his immune cells that were donated were not resistant to HIV.
The circumstances surrounding those two recent occurrences in Europe raise serious concerns about what really goes into an effective HIV cure.
Not involved in the German man’s care, but a prominent researcher on HIV cures at the University of California, San Francisco, Dr. Steven Deeks, stated of his case, “the level of protection one might have predicted from transplant should not have been enough to prevent the virus from surviving and rebounding.” “I am hopeful we will learn something here that could shape the next generation of cure studies, as there are several testable theories.”
According to Gaebler, the likelihood of successfully treating the virus with a stem cell transplant is unquestionably increased when HIV-resistant immune cells are included in the mix. Nevertheless, he said, success is not impossible even in the absence of such safety net—or even if it has some gaps, as with the German guy.
He said, “We need to know how the new immune system effectively grafted into his body and how it gradually eliminated HIV reservoirs.” “The donor’s innate immune system might have played an important role here,” he added, implying that the immune cells that were transferred might have targeted the viral reservoir.
The six others had HIV treated or perhaps cured.
Because of the settings in which they were treated, everyone was first identified by pseudonyms.
Also known as the “Berlin patient,” Timothy Ray Brown AML treatment was received for Brown, an American residing in Germany. The 2008 announcement of his case sparked a surge of interest in HIV research. He was born in 1966, had an HIV cure, and passed away in 2020 from recurring leukemia.
“London patient,” also known as Adam Castillejo The 44-year-old Venezuelan resident of England, Castillejo, had an AML stem cell transplant in 2016 and ceased taking HIV medication in 2017. It is thought that he is healed.
The “Düsseldorf patient,” Marc Franke Franke, 55, who had stem cell treatment for acute myeloid leukemia in 2013; he stopped taking antiretrovirals in November 2018 and is now deemed cured.
The “patient from the City of Hope,” Paul Edmonds Due to his advanced age, Edmonds, who was the oldest possible cure case when he had a stem-cell transplant for AML in 2019, was given lower-intensity chemotherapy. He has been off antiretrovirals since March 2021; if he goes five years without experiencing a viral resurgence, he will be deemed cured. In an interview, he said, “My vision is clear: a world where HIV is no longer a sentence, but a footnote in history,” and he expressed enthusiasm about the recent instance of a guy who was likely also healed.
“Patient from New York.” Her leukemia diagnosis in 2017 made her the first lady of mixed-race descent to potentially be healed. She had a stem cell transplant supplemented with umbilical cord blood, which allowed for a lower genetic match with her donor, hence expanding the pool of potential donors.
The “patient from Geneva.” He was given a rare blood cancer diagnosis in 2018 and has not had HIV therapy since November 2021. He is in his 50s. Because his immune cells are not HIV resistant, researchers are still hesitant to declare him cured.
The now-friends Franke, Edmonds, and Castillejo are anticipated at the HIV conference in Munich.
