London man becomes second in world to be cured of HIV

Unexpectedly, the stem cell treatment - from a donor with a mutation of the CCR5 gene, which is a co-receptor for the HIV-1 infection - ended up with Brown's HIV going into remission, where is has remained ever since. And now, a year and a half after he last took antiretroviral medications, the London patient is no longer showing signs of the virus.

The London patient, who was being treated for cancer, has now been in remission from HIV for 18 months and is no longer taking HIV drugs.

Although Brown almost died after he was given strong immunosuppressive drugs and was put into a coma, the "London patient" did not come that close; he suffered from Hodgkin's lymphoma and received a similar bone-marrow transplant to Brown's, but the immunosuppressive drugs he received were gentler.

Fauci sees the report of the London patient as being less about the possible benefits of bone marrow transplants in treating or even curing HIV, and more about the need to focus HIV research on CCR5. Brown was treated using stem cells, effectively transplanting his immune system, because he had an unrelated cancer, and the chemotherapy was interfering with the antiretroviral drugs that had previously controlled his infection.

Dr. Timothy Henrich, an associate professor of medicine and physician scientist at University of California, San Francisco's Department of Medicine, also noted that the London patient's treatment "is not a scalable, safe or economically viable strategy to induce HIV remission".

Blood cells of an infected person are replaced by someone who is immune to HIV through a genetic mutation which stops the virus attaching to cells.

In both instances, the HIV-infected patient was treated using bone-marrow transplants that were actually created to treat cancer patients and not HIV.

The case was published online Monday by the journal Nature and will be presented at an HIV conference in Seattle. He has become the second man to be cleared of the virus.

The donor was resistant because of a mutation in his CCR5 gene. Brown had also received a transplant without functioning CCR5 genes.

A new drug-resistant form of HIV is also a growing concern. Today people can live normal lives with HIV and, as best as we can tell, live to a full age. Both the Berlin and London patients had this complication, which may have played a role in the loss of HIV-infected cells, Gupta said.

The patient from London has not been named, and was first diagnosed with HIV in 2003, as well as advanced Hodgkin's lymphoma in 2012.

The first case was reported in 2007 when a HIV-positive American citizen, identified as Timothy Brown, who had undergone a similar treatment later tested HIV-negative.

Though the experts are excited with results, they remained conservative about the current capabilities of replicating the "cure" since tens of millions of people affected by HIV worldwide.

There have been other attempts to discontinue anti-retroviral therapy for HIV+ bone marrow transplant recipients, but in these cases the patient's virus has returned.

Gupta described his patient as "functionally cured" and "in remission", but cautioned, "It's too early to say he's cured".

"I think this does change the game a little bit", Gupta opined to NYT of the new patient, who had less invasive treatment than Brown.


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