Scientists report milestone in AIDS epidemic

Action on AIDS

A patient seems to be cured of infection with H.I.V., the virus that causes AIDS, for only the second time since the global epidemic began in the early 1980s, according to an article by Apoorva Mandavilli in the New York Times. Scientists appear to have succeeded in duplicating the procedure that led to the first long-term remission 12 years ago.

The investigators will publish their report in the journal Nature and present some of the details at the Conference on Retroviruses and Opportunistic Infections in Seattle. While they call the case a long-term remission, most experts say it is a cure, although there are only two known instances. Both cases involved bone-marrow transplants on infected patients, but the transplants were supposed to treat cancer in the patients, rather than H.I.V.

Strong drugs can control H.I.V. infection, while transplants are risky, with long-lasting, harsh side effects. While bone-marrow transplantation may not be a realistic treatment option in the near future, fortifying the body with immune cells modified to resist H.I.V. could become a practical treatment, experts said.

According to Dr. Annemarie Wensing, a virologist at the University Medical Center Utrecht in the Netherlands, “This will inspire people that cure is not a dream. It’s reachable.”

As the article explained, Dr. Wensing is co-leader of IciStem, a consortium of European scientists who are exploring stem cell transplants to treat H.I.V. infection. The group is supported by AMFAR, the American AIDS research organization.

While the new patient wants to remain anonymous, and the scientists call him the “London patient,” he said that he feels “a sense of responsibility to help the doctors understand how it happened so they can develop the science.” Finding that he could be cured of both cancer and H.I.V. infection was “surreal” and “overwhelming.”

In 2007, a German doctor described the first cure in the “Berlin patient,” who was later identified as Timothy Ray Brown, 52. When it became clear that Brown had really been cured, scientists tried to duplicate the result. However, the virus came back in every other case, usually about nine months after the patients stopped taking antiretroviral drugs, or the patients died of cancer.

After chemotherapy on Brown’s leukemia was unsuccessful, he had two bone-marrow transplants from a donor with a mutation in a protein called CCR5, which lies on the surface of certain immune cells. While H.I.V. uses the protein to enter those cells, it cannot latch on to the mutated version. Brown received harsh immunosuppressive drugs that are no longer used and suffered serious complications long after the transplant. Placed in an induced coma, he almost died.

The London patient, who had Hodgkin’s lymphoma, received a bone-marrow transplant from a donor with the CCR5 mutation in May 2016. He also took immunosuppressive drugs. He stopped taking anti-H.I.V. drugs in September 2017, making him the first patient since Brown to stay virus-free for more than a year after stopping. The transplant killed the cancer without harmful side effects. The transplanted immune cells, now resistant to H.I.V., appear to have completely replaced his vulnerable cells.