AIDS researchers announced on Wednesday that a fourth person has been “cured” of HIV, but the dangerous procedure for patients who are also battling cancer may be of little comfort to the millions of people living with the virus worldwide.
The 66-year-old man, dubbed a “City of Hope” patient after the California center where he was treated, went into remission ahead of the International AIDS Conference that begins Friday in Montreal, Canada explained.
He is the second person to be reported cured this year after researchers said in February that a US woman, dubbed a New York patient, has also gone into remission.
The City of Hope patient, like those in Berlin and London before him, achieved durable remission of the virus after undergoing a bone marrow transplant to treat cancer.
Another man, the Dusseldorf patient, is also said to have previously achieved remission, potentially bringing the number healed to five.
Jana Dickter, an infectious disease specialist in the City of Hope, told AFP that its success could show promise for older HIV patients who also have cancer, as the youngest patient was the oldest to have achieved remission so far .
Dickter is the lead author of the research on the patient, which was announced but not peer-reviewed at a pre-conference in Montreal.
– ‘I am eternally grateful’ –
“When I was diagnosed with HIV in 1988, like many others, I thought it was a death sentence,” says the patient, who asked not to be named.
“I never thought I would see the day when I was no longer HIV,” he said in a City of Hope statement. “I am beyond grateful.”
Dickter said the patient told her about the stigma he experienced in the early days of the AIDS epidemic in the 1980s.
“He saw many of his friends and family become very ill and eventually succumb to the disease,” she said.
He had “full-blown AIDS” for a time, she said, but was part of early trials of the antiretroviral therapy that now allows many of the 38 million people living with HIV worldwide to live with the virus.
He had had HIV for 31 years, longer than any other patient who went into remission.
In 2019, after being diagnosed with leukemia, he received a bone marrow transplant using stem cells from an unrelated donor with a rare mutation missing part of the CCR5 gene, which makes people resistant to HIV.
He waited until he was vaccinated against Covid-19 in March 2021 to stop taking antiretroviral drugs and has since been in remission from both HIV and cancer.
Reduced-intensity chemotherapy worked for the patient and potentially allowed older HIV patients with cancer to receive the treatment, Dickter said.
But it’s a complex procedure with serious side effects and “not a viable option for most people living with HIV,” she added.
Steven Deeks, an HIV expert at the University of California, San Francisco who was not involved in the research, said “the first thing you do in a bone marrow transplant is you temporarily destroy your own immune system.”
“You would never do this if you didn’t have cancer,” he told AFP.
– ‘Holy Grail’ –
Also announced at the AIDS conference was a study of a 59-year-old Spanish woman living with HIV who had maintained an undetectable viral load for 15 years despite stopping antiretroviral therapy.
Sharon Lewin, president-elect of the International AIDS Society, which is convening the conference, said it wasn’t quite the same as the City of Hope patient because the virus had remained at very low levels.
“A cure remains the holy grail of HIV research,” said Lewin.
“We have previously seen a handful of individual cures, and the two presented today provide lasting hope to people living with HIV and inspire the scientific community.”
She also pointed to a “really exciting development” in identifying HIV in a single cell, which is “a bit like looking for a needle in a haystack.”
Deeks, an author of the new research also presented at the conference, said it was an “unprecedented deep dive into the biology of the infected cell.”
The researchers found that a cell with HIV has several special characteristics.
It can reproduce better than most, is difficult to kill, and is both resilient and difficult to detect, Deeks said.
“That’s why HIV is a lifelong infection.”
But he said cases like the City of Hope patient offer a potential roadmap for a more widely available cure, potentially using CRISPR gene-editing technology.
“I think if you can get rid of HIV and get rid of CCR5, the door that HIV comes in through, then you can heal somebody,” Deeks said.
“It’s theoretically possible – we’re not there yet – to put an injection in someone’s arm that releases an enzyme that gets into the cells and knocks out CCR5 and the virus.
“But that’s science fiction for now.”
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