Fifth person cured of HIV after stem cell transplant

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A fifth known person has likely been cured of HIV following a specialized stem cell transplant. According to the man’s doctors, he lived essentially virus-free for about a decade. Although the treatment is not practical for the general population living with HIV, the insights gained from these patients may help scientists find a more scalable treatment in the future.

The 53-year-old German resident, known only as the Dusseldorf patient (after the city in Germany) underwent the procedure more than nine years ago. He needed the stem cell transplant to help treat a case of acute myeloid leukemia, a form of cancer that affects white blood cells. But his doctors had the opportunity to rebuild his immune system with bone marrow from a matched donor from someone with a rare genetic mutation that gives him natural resistance to HIV-1, the most common type of virus. more frequent.

Although the man had experienced a few health issues over the years (including a brief recurrence of his cancer a few months after the transplant), his HIV viral load remained consistently undetectable while on antiretroviral therapy. At the same time, some tests suggested his body still contained traces of HIV RNA and DNA, while others indicated that no surviving fragments would be able to replicate and restart the infection. Finally, in 2018, his doctors made the choice to completely wean him off anti-HIV treatment and monitor him closely. Fortunately, more than four years later, the infection has not returned and they feel confident enough to declare him cured of HIV.

“Four years after discontinuation of analytical processing, the absence of viral rebound and the absence of immunological correlates of HIV-1 antigen persistence are strong evidence for HIV-1 cure,” they write in their article, published Monday in natural medicine.

There have been four other reports of patients being cured after receiving this type of stem cell transplant, including two announcement Last year. Generally, the physicians involved are meticulous to state that their patient only achieved long-term remission and that it would take longer to confirm a true cure. But this case now appears to be one of the longest gaps between the procedure and continued HIV-free status.

There have been some improvements over the years in the viability of these transplants for HIV patients. Last year, doctors reported about a woman who achieved prolonged remission after receiving umbilical cord blood, which meant her donor only needed to be partially matched. But these procedures are still a high-risk procedure that comes with many potential complications, which is why they are usually used as a last resort for other conditions like leukemia. And there has been at least one recent case where this kind of transplant failed to completely eliminate HIV from a patient.

Although these limitations mean that donor stem cells transplants will never become a standard cure for HIV, they could open up new avenues of research and eventually lead to a truly practical treatment, experts have said. Some researchers are Already studying whether it is possible to genetically modify a recipient’s own immune cells to become resistant to HIV in the laboratory and then transplant them back, for example.

Meanwhile, the Düsseldorf patient’s doctors say they have since treated several other patients with donor stem cells, with equally positive initial results, although it is still too early to declare them cured.

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