Two more HIV patients survive without antiretroviral drugs

MONTREAL – A man who once held the record for HIV infection is now one of the few in the world to have successfully cured the disease that causes AIDS, in remission of acute leukemia, researchers report here .

The so-called “City of Hope patient” is a 66-year-old man who was first diagnosed with the AIDS-defining disease in 1988 City of Hope, Duarte, California Jana Dickter, MD, an infectious disease specialist at the medical center, was then diagnosed with acute leukemia in 2019, speaking at the 2022 International AIDS Congress.

When leukemia treatment requires a stem cell transplant, doctors look for a donor with a homozygous delta mutation in CCR5 that fights HIV, Dickter said.

She said the patient received his hematopoietic stem cell transplant 3.5 years ago, had been off antiretroviral therapy for 17 months, and had no evidence of HIV replication in his body. “His Acute leukemia is also in complete remission,” she said.

achieved HIV remission,” Dickett added. “At age 63, he was the most successful recipient of HIV and leukemia stem cell transplantation and remission from both diseases. older people. He’s also the longest HIV-infected person of all — over 31 years, before the transplant. “

But City of Hope patients aren’t the only ones discussing at a news conference that they haven’t had HIV rebound for years without treatment.

Dr. Nuria Climent, a research scientist at the JM Miro Hospital Clinic, University of Barcelona, ​​details her “Barcelona patient” – a 59-year-old sexually infected HIV woman who participated in a clinical trial in acutely HIV-infected individuals Different HIV control strategies. Rebound after stopping treatment,” she reported. “However, few patients, such as post-treatment controllers, were able to maintain viral loads below the detection limit without the use of antiretroviral drugs, a realistic model of a functional cure for HIV.”

She reported that the Barcelona patient maintained HIV control more than 15 years after stopping treatment. During her early infection, researchers were able to culture the virus from her blood, Clement said. Her blood cells were supposed to be vulnerable to HIV, but displayed natural resistance to the virus. Analysis of natural killer cells and CD8 T cells may reveal clues that could be used for future treatments, Climent said. “Strategies that can expand these cells may help achieve a functional cure for HIV,” she said.

“Cure remains the Holy Grail of HIV research,” said Sharon Lewin, MD, PhD, President-Elect of the International AIDS Society and Professor of Medicine at the University of Melbourne, Australia. “We’ve seen a handful of cured cases before, and the two cases presented here provide continued hope for people living with HIV and an inspiration for the scientific community. The City of Hope patient was the oldest and was infected before him HIV has been around for the longest time. Current treatments.”

“Furthermore, we are now seeing progress in the great challenge of finding biomarkers of HIV hosts – which It’s a really exciting development,” she said.

Commenting on her City of Hope patient, Dickett said he seemed to benefit from the environment surrounding the stem cell transplant: The donor cell contained the CCR5 delta32 mutation, and he received a less intense The chemotherapy regimen, City of Hope, was developed for older and less-fit patients, making them more likely to receive allogeneic stem cells to treat blood cancers.

“This experience has given some patients the hope of not needing the full intensive chemotherapy ablation of stem cell transplants to free them from HIV and leukemia,” Dickett said. “This is important because people with HIV tend to live longer due to advances in HIV treatment.”

These patients are among at least five in the world to achieve long-term HIV remission. The other two patients included the Berlin patient, the London patient and the Brazilian patient.

Berlin patient died after leukemia relapse. He has been HIV free for about 15 years. The London patient has been HIV-free for about 4 years after stopping antiretroviral drugs and remains well. A Brazilian patient was in remission for more than 15 months before his viral load increased again in the summer of 2020.

Since 1981, this day is considered by most to be the beginning of the HIV epidemic, with more than 50 million people worldwide infected with HIV.

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  Ed Susman is a freelance medical writer based in Fort Pierce, Florida, USA.