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to Section One | to Arts & Entertainment
posted Friday, March 8, 2019 - Volume 47 Issue 10
Second patient 'cured' of HIV - Stem cell transplants not a practical treatment, doctors warn
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Second patient 'cured' of HIV - Stem cell transplants not a practical treatment, doctors warn

by Mike Andrew - SGN Staff Writer

A second HIV patient has been 'cured' of the virus, but doctors warn that the treatment - chemotherapy plus stem cell transplants - is not a practical method for dealing with HIV infections.

The British patient, who has not been identified, was diagnosed with HIV in 2003 and advanced Hodgkin's lymphoma, a form of cancer, in 2012.

He had chemotherapy to treat the cancer and, in addition, stem cells were implanted into the patient from a donor resistant to HIV, leading to both his cancer and HIV going into remission.

He has now been in remission from HIV for 18 months and is no longer taking HIV drugs. However, doctors working on the case say it is too early to say the patient is cured of HIV. And they warn that the approach is not practical for treating most people with HIV but may one day lead to a cure.

Researchers from University College London (UCL), Imperial College London, and Cambridge and Oxford Universities were all involved in the case.

This is the second time a patient treated this way has ended up in remission from HIV. Ten years ago, another patient in Berlin received a bone-marrow transplant from a donor with natural immunity to the virus.

Timothy Brown, said to be the first person to 'beat' HIV, was given two transplants and total radiation therapy for leukemia, a much more aggressive treatment than was used in the British case.

'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,' said lead study author Prof Ravindra Gupta, from UCL.

Why this is not a 'cure' but could lead to one Chemotherapy plus the stem cell transplant were used primarily to treat the patient's cancer, not his HIV. Current HIV therapies are very effective, allowing people with the virus to live long and healthy lives. But this new case is significant because it could help researchers who are looking for new ways to tackle HIV and achieve a real cure.

Professor Eduardo Olavarria of Imperial College London, also involved in the current case, said the success of stem cell transplantation offered hope that new strategies could be developed to tackle the virus.

But he added, 'The treatment is not appropriate as a standard HIV treatment because of the toxicity of chemotherapy, which in this case was required to treat the lymphoma.'

How did it work? The treatment 'worked' - eliminated HIV - by interfering with the protein receptor that allows HIV to penetrate healthy cells.

CCR5 is the most commonly used receptor by HIV-1, the virus strain of HIV that dominates around the world, to enter cells. A very small number of people who are resistant to HIV have two mutated copies of the CCR5 receptor.

This means the virus cannot penetrate cells in the body that it normally infects.

The London patient received stem cells from a donor with this specific genetic mutation, which made him resistant to HIV as well. But a reservoir of cells carrying HIV can still stay dormant in the body for many years.

The UK researchers say it may be possible to use gene therapy to target the CCR5 receptor in people with HIV, now that they know the Berlin patient's recovery was not unique.

Dr. Andrew Freedman, reader in infectious diseases and honorary consultant physician at Cardiff University, said it was an 'interesting and potentially significant report.'

But he said much longer follow-up would be needed to ensure the virus did not re-emerge at a later stage.

'While this type of treatment is clearly not practical to treat the millions of people around the world living with HIV, reports such as these may help in the ultimate development of a cure for HIV,' he said.

In the meantime, he said the focus needed to be on diagnosing HIV promptly and starting patients on lifelong combination antiretroviral therapy.

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