Bone mar­row trans­plant sparks long-term re­mis­sion in sec­ond HIV pa­tient, re­new­ing hope for a cure

The cau­tious­ly op­ti­mistic call it sus­tained re­mis­sion, oth­ers are hope­ful it is a cure — but the doc­tors are im­pressed. An un­named pa­tient in Lon­don, once af­flict­ed with can­cer and the virus that caus­es AIDS, is free of both, cour­tesy an im­mune sys­tem over­haul trig­gered by a bone mar­row trans­plant from an HIV-re­sis­tant donor.

The case comes a dozen years or so af­ter the “Berlin pa­tient” — now iden­ti­fied as Tim­o­thy Ray Brown — who achieved sus­tained re­mis­sion fol­low­ing the same pro­ce­dure for his leukemia. Al­though Brown un­der­went two trans­plants, was giv­en to­tal body ir­ra­di­a­tion no longer in use to­day, and was placed in an in­duced co­ma, he even­tu­al­ly re­cov­ered and was deemed HIV-free. Sci­en­tists took note, and tried re­peat­ed­ly to du­pli­cate the feat, but in vain.

Ravin­dra Gup­ta

On Tues­day re­searchers from Uni­ver­si­ty Col­lege Lon­don and Im­pe­r­i­al Col­lege Lon­don, to­geth­er with teams at the Uni­ver­si­ty of Cam­bridge and the Uni­ver­si­ty of Ox­ford, re­port­ed the sec­ond known case of sus­tained re­mis­sion — in an in­di­vid­ual who asked to re­tain his anonymi­ty and is ac­cord­ing­ly just re­ferred to as the “Lon­don pa­tient”.

Both Brown and the Lon­don pa­tient re­ceived do­na­tions from donors with two copies of the al­lele that pre­vents the ex­pres­sion of CCR5, a gene com­mon­ly used by HIV as a back door in­to a cell. The trait is nat­u­ral­ly com­mon in parts of North­ern Eu­rope and con­fers the abil­i­ty to re­sist an HIV in­fec­tion from the AIDS virus. It is this trait that rogue Chi­nese sci­en­tist Jiankui He at­tempt­ed to con­fer via gene edit­ing in his wide­ly con­demned CRISPR ex­per­i­ment ear­li­er this year that cul­mi­nat­ed in the birth of two ge­net­i­cal­ly mod­i­fied twin ba­by girls.

The Lon­don pa­tient was di­ag­nosed with an HIV in­fec­tion in 2003, and in 2012 he be­gan tak­ing an­ti­retro­vi­ral (ARV) ther­a­py. Lat­er that year, it was con­firmed he had ad­vanced Hodgkin’s Lym­phoma. On top of chemother­a­py, he un­der­went the stem cell trans­plant in 2016. The surgery was rel­a­tive­ly un­com­pli­cat­ed, but not with­out side ef­fects, in­clud­ing mild graft-ver­sus-host dis­ease.

Chemother­a­py can be used to thwart HIV as it snuffs out cells that are di­vid­ing – and the re­searchers sug­gest that re­plac­ing im­mune cells de­void of the CCR5 re­cep­tor ap­pears to be the cru­cial in­gre­di­ent pre­clud­ing HIV from mak­ing a come­back.

Ed­uar­do Olavar­ria

Fol­low­ing the trans­plant, for 16 months the Lon­don pa­tient was giv­en ARV ther­a­py, af­ter which his treat­ment was in­ter­rupt­ed to eval­u­ate whether he was tru­ly in HIV re­mis­sion. Reg­u­lar and sen­si­tive test­ing has con­firmed that the pa­tient has in­deed re­mained in re­mis­sion 18 months since ARV ther­a­py was ceased.

“We need to un­der­stand if we could knock out this re­cep­tor in peo­ple with HIV, which may be pos­si­ble with gene ther­a­py,” said lead au­thor of the study Ravin­dra Gup­ta, in a state­ment.

Gup­ta was at UCL when the study — to be pub­lished in the jour­nal Na­ture on Tues­day — was con­duct­ed; he has since moved to the Uni­ver­si­ty of Cam­bridge.

“While it is too ear­ly to say with cer­tain­ty that our pa­tient is now cured of HIV, and doc­tors will con­tin­ue to mon­i­tor his con­di­tion, the ap­par­ent suc­cess of haematopoi­et­ic stem cell trans­plan­ta­tion of­fers hope in the search for a long-await­ed cure for HIV/AIDS,” added Pro­fes­sor Ed­uar­do Olavar­ria from Im­pe­r­i­al Col­lege Lon­don.

Ac­cord­ing to the WHO, there are near­ly 37 mil­lion peo­ple glob­al­ly liv­ing with HIV — of which rough­ly 60% are on ARV, as of 2017. Once a death sen­tence, the virus that caus­es AIDS is typ­i­cal­ly sup­pressed us­ing ARV ther­a­py and is now up­grad­ed to the po­si­tion of a chron­ic dis­ease.

John Hood [file photo]

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On June 18, 2019, we initiated a confidential arbitration proceeding against Dr. Asa Abeliovich, our former consulting co-founder, related to alleged breaches of his consulting agreement and the improper use of our confidential information that he learned during the course of rendering services to us as our consulting Chief Scientific Officer/Chief Innovation Officer. We are in the early stage of this arbitration proceeding and are unable to assess or provide any assurances regarding its possible outcome.

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