A second patient has attained sustained remission of HIV-1 after cessation of treatment, according to a press release from the University College of London.
Researchers at the University College of London and the Imperial College London report that the patient has been in remission for 18 months after discontinuation of antiretroviral therapy (ART), documented by regular testing of the patient’s viral load. Akin to the first patient to report such an event, this individual was also a recipient of a hematopoietic stem cell transplant.
The patient is a male resident of the United Kingdom who was diagnosed with HIV in 2003 and had been receiving ART since 2012. In 2012, he was diagnosed with advanced Hodgkin’s Lymphoma, for which he received moderate-intensity chemotherapy and a stem cell transplant in 2016.
The donor, researchers noted, possessed 2 mutated copies of the CCR5 allele — similar to the donor in the first case of HIV remission. Individuals with 2 copies of this genetic mutation are resistant to HIV infection, as the mutation prevents expression of the virus.
Researchers also noted that chemotherapy alone may contribute to eradicating HIV infection, as it kills dividing cells and allows for replacement of immune cells with cells that do not have the CCR5 receptor.
The transplant was complicated by a mild case of graft-vs-host disease, which is similar to the first patient to achieve HIV remission. Researchers posited that this phenomena in both patients may have played a role in the loss of HIV-infected cells.
Achieving remission in a second patient with HIV using similar methods demonstrated that the first occurrence was not anomalous. However, citing the use of total body radiotherapy in the first individual, but not in the management of the current patient, researchers highlighted the importance of future strategies for HIV remission to be based on preventing CCR5 expression.
Professor Eduardo Olavarria, MD, PhD, of the Imperial College Healthcare NHS Trust and the Imperial College London stated that “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 hematopoietic stem cell transplantation offers hope in the search for a long-awaited cure for HIV/AIDS.”
HIV remission achieved in second patient [press release]. London, England: University College of London; March 5, 2019. https://www.ucl.ac.uk/news/2019/mar/hiv-remission-achieved-second-patient. Accessed March 5, 2019.