HIV-1 remission sparks cure hope

The new case of HIV remission occurred in a patient referred to as the ‘London patient’, who was diagnosed with HIV in 2003 and had been on antiretroviral therapy since 2012.
 
Later that year, he was diagnosed with advanced Hodgkin’s lymphoma and received chemotherapy and a bone marrow transplant from a donor with two copies of a CCR5 gene variant.
 
Sixteen months after transplantation, the London patient’s antiretroviral therapy was interrupted and HIV-1 remission was maintained for a further 18 months. Regular testing has confirmed that his viral load has remained undetectable since then.
 
The case, reported in the journal Nature, has led experts to announce the virus may one day be curable.
 
‘It is a landmark. After 10 years of not being able to replicate (the first case), people were wondering if this was a fluke,’ lead author Professor Ravindra Gupta from the University of Cambridge, said.
 
‘I think it is important to reaffirm that this is real and it can be done.’
 
The first ever confirmed case of an HIV-infected person being rid of the disease occurred 10 years ago and was referred to at the time as the ‘Berlin patient’.
 
The Berlin patient, later revealed to be American Timothy Brown, had HIV and was then diagnosed with acute myeloid leukaemia.
 
As part of his treatment for blood cancer, Brown underwent a bone marrow transplant from a donor with a genetic mutation present in the HIV co-receptor CCR5, a mutation that prevents HIV from taking hold.
 
While his remission from HIV was hopeful, Brown’s treatment involved two bone marrow transplants as well as total body irradiation – a process that nearly killed him.
 
Unlike the first case, the London patient did not receive radiation as part of his treatment, nor did he require two rounds of chemotherapy. Also, the chemotherapy he received was a milder form.
 
‘By achieving remission in a second patient using a similar approach, we have shown that the Berlin Patient was not an anomaly, and that it really was the treatment approaches that eliminated HIV in these two people,’ Professor Gupta said.
 
‘Continuing our research, we need to understand if we could knock out this receptor in people with HIV, which may be possible with gene therapy.’
 
While this news is positive, experts are also keen to point out the techniques used to achieve this outcome are likely to only be viable for a tiny percentage of sufferers.
 
‘Due to the rarity of suitable donors, this precise approach will not be available to all HIV patients,’ Aine McKnight, professor of Viral Pathology at Queen Mary University, said.
 
Despite these reservations, this second case of remission offers hope to the millions of people with HIV worldwide, with the International AIDS Society stating recently that the London patient ‘reaffirm(s) our belief that there exists a proof of concept that HIV is curable’.
 
According to the Australian Federation of AIDS Organisations, in 2017 it was estimated that there were 27,545 people with HIV in Australia.

HIV remission