What the 'London patient' means for HIV/AIDS research

Berlin patient’ Timothy Brown was cured of HIV over a decade ago. AP

Acute myeloid leukaemia patient Timothy Brown, who became known as the "Berlin patient", was treated aggressively more than a decade ago in an HIV-curing approach which hasn't been successfully repeated until Professor Ravindra Gupta and colleagues showed the effectiveness of a less aggressive form of treatment.

According to doctors, the person who had donated the stem cells to the London patient had a rare genetic mutation that can only be found in 1% of northern Europeans.

For the second time since the global epidemic begun, scientists claim to have "cured" a HIV patient.

Bone marrow transplant is a high-risk, life-threatening procedure.

Later that year, he was diagnosed with advanced Hodgkin's Lymphoma, a deadly cancer.

Before yesterday some researchers had posited a third theory: That it was the intense combination of radiation and chemotherapy ahead of the stem-cell transplant that floored the virus.

The CCR5 gene, and the eponymous cell it codes for, nearly certainly play a crucial role in the collateral HIV cure.

The patient had voluntarily agreed to stop taking his HIV medications to observe the return of the virus - which did not happen over the course of 18 months! "However, the case is important as it reaffirms that the CCR5 receptor is a candidate for future research approaches in HIV remission".

Many patients now have good control of their disease with treatments such as Gilead's anti-retroviral drug Biktarvy, which combines three HIV medicines in a single daily tablet.

The agency stressed that as stem cell transplants are "highly complex, intensive and costly procedures with substantial side-effects", they were not a "viable way of treating large numbers of people living with HIV".

A coloured transmission electron micrograph of the HIV virus (green) attaching to a white blood cell (orange).

An unnamed man in London could be the second person in history to be ever cured of HIV infection, offering hope that HIV and AIDS are curable.

But replacing immune cells with those that do not have the CCR5 receptor appears to be key in preventing HIV from rebounding after the treatment.

Some 37 million people across the globe have HIV. In people who have the CCR5 mutation, the virus is unable to enter cells and thus can not cause infection.

"I think it's getting close to something that should be called a cure", Brown told aidsmap.

This new case in London also used a stem cell transplant.

The research team for the London patient will present their findings at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, Washington.

He added that both the Berlin and London patients had this complication, which could have played a role in the loss of HIV-infected cells.

The London breakthrough offers hope for a potential cure using gene manipulation and antibody technology to develop next generation therapeutics for an infection on which at least half a trillion dollars (US $562.6 billion) have been spent worldwide between 2000 and 2015.

"In the second theory, you are mixing two immune systems, with your new immune system reacting against your original one", Lewin said.



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