For just the second time
ever an HIV patient is in sustained remission from the virus in what was hailed
by experts on Tuesday as proof that the AIDS-causing condition could one day be
curable.
Ten years almost to the
day since the first confirmed case of an HIV-infected person being rid of the
deadly disease, a man known only as the "London patient" has shown no
sign of the virus for nearly 19 months, doctors reported in the journal Nature.
Both patients underwent
bone marrow transplants to treat blood cancers, receiving stem cells from
donors with a genetic mutation present in less than one percent of Europeans
that prevents HIV from taking hold.
"It is a landmark.
After 10 years of not being able to replicate (the first case), people were
wondering if this was a fluke," said lead author Ravindra Gupta, a
professor at the University of Cambridge.
"I think it is
important to reaffirm that this is real and it can be done," Gupta told
AFP.
The findings will be
presented later Tuesday at a medical conference in Seattle, Washington.
Millions of people
infected with HIV around the globe keep the disease in check with so-called
antiretroviral therapy (ARV), but the treatment does not rid patients of the
virus.
Close to 37 million
people are living with HIV worldwide, but only 59 percent are receiving ARV.
Nearly one million people die every year from HIV-related causes.
A new drug-resistant form
of HIV is also a growing concern.
The first sustained
remission survivor, announced in 2009 as "the Berlin patient" and
later named as American Timothy Brown, was given two transplants and underwent
total body irradiation to treat leukaemia -- a process that nearly killed him.
Gupta said that while a
second successful transplant did not constitute a generalised cure, it showed
that even milder forms of treatment can achieve full remission.
"There are a number
of learning points here," he said. "Radiation has a lot of
side-effects and leads to a delayed recovery of the bone marrow, so it's really
good that we've shown you don't need radiation.
"The Berlin patient
also had two rounds of chemotherapy because the first one didn't work. We've
done ours just once, and it was also a milder form, which is important,"
he added.
Both patients received
stem cell transplants from donors carrying a genetic mutation that prevents
expression of an HIV receptor, known as CCR5.
The London patient was
diagnosed with HIV infection in 2003 and had been on antiretroviral therapy
since 2012.
Later that year, he was
diagnosed with advanced Hodgkin's Lymphoma, a deadly cancer.
He underwent a stem cell
transplant in 2016 from a donor with two copies of a CCR5 gene variant, which
is resistant to most HIV-1 virus strains.
"CCR5 is something
essential for the virus to complete its life-cycle and we can't knock out many
other things without causing harm to the patient," said Gupta.
"We know that CCR5
can be knocked out without any serious consequences because people are walking
around without that gene."
CCR5 was the target in
the genome of the controversial gene-edited twins born last year in China,
whose father is HIV-positive.
Experts cautiously welcomed
Tuesday's announcement.
The International AIDS
Society said in a statement Tuesday that results from the second patient
"reaffirm our belief that there exists a proof of concept that HIV is
curable".
Sharon Lewin, director of
the Peter Doherty Institute for Infection and Immunity, told AFP that the
second case showed a cure was "feasible".
"We can try to tease
out which part of the transplant might have made a difference here, and allowed
this man to stop his anti-viral drugs," she added.
After the bone marrow
transplant, the London patient remained on ARV for 16 months, at which point
treatment was stopped.
Regular testing has
confirmed that the patient's viral load remained undetectable since then.
But scientists were keen
to stress that the technique is likely only viable among a tiny percentage of
sufferers.
"Due to the rarity
of suitable donors, this precise approach will not be available to all HIV
patients," said Aine McKnight, professor of Viral Pathology at Queen Mary
University, London.
"However, this work
has the potential to stimulate research into more generally applicable
therapies."
Gupta said he hoped to
expand research on the stem-cell transplant technique to focus on communities
in Africa, where the HIV-beating mutation does not naturally occur. (AFP)
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