While we’re all trying to figure out how to deal with COVID-19, let’s take a minute to focus on another virus: HIV. A study of the second HIV patient to undergo successful stem cell transplantation from donors with an HIV-resistant gene shows that there is no active viral infection in the patient’s blood 30 months after he stopped this anti-retroviral therapy. Doctors are calling him cured.
The study was published in The Lancet HIV Journal. The study authors explained that though remnants of integrated HIV-1 DNA remained in tissue samples, they suggest they can be seen as “fossils” and unlikely of reproducing.
“We propose that these results represent the second ever case of a patient to be cured of HIV. Our findings show that the success of stem cell transplantation as a cure for HIV, first reported nine years ago in the Berlin patient, can be replicated,” said lead author on the study, Professor Ravindra Kumar Gupta from the University of Cambridge.
“It is important to note that this curative treatment is high-risk, and only used as a last resort for patients with HIV who also have life-threatening haematological malignancies. Therefore, this is not a treatment that would be offered widely to patients with HIV who are on successful antiretroviral treatment.”
HIV, which was once seen as a death sentence, is now regarded as a chronic illness that can be managed with medication and lifestyle adjustments. Many with HIV can live long and healthy lives. However, experimental research such as stem cell transplantation can help scientists figure out how a more widely applicable cure may be created in the future.
The first patient reportedly cured of HIV was referred to as the “Berlin” patient. Their treatment included total body irradiation, two rounds of stem cell transplant from a donor who carried a gene resistant to HIV, and a chemotherapy drug regimen.
The patient in this study—formerly referred to as the “London patient”—recently went public with his identity. 41-year-old Adam Castillejo underwent one stem-cell transplantation, a reduced-intensity chemotherapy drug regimen, without whole-body irradiation.
In 2019, it was reported that his HIV was in remission. Further results showed no active viral infection detected in samples of Castillejo’s blood at 30 months, or in his cerebrospinal fluid, semen, intestinal tissue, and lymphoid tissue 29 months after stopping therapy. 99% of the patient’s immune cells were derived from the donor’s stem cells, indicating the stem-cell transplant had been successful.
The authors explain that their case study demonstrates a move towards less intensive treatment, showing that long-term remission of HIV can be achieved with drug regimens, one stem cell transplant instead of two, and without total body irradiation. Since Castillejo is only the second patient to undergo this treatment successfully, doctors will still be monitoring him for signs of the virus re-emerging.
Castillejo was diagnosed with HIV in 2003. In 2011, he found out he had stage 4 lymphoma. Treating both HIV and cancer often led doctors into unexplored territory, which forced them to try new things.
“I don’t want people to think, ‘Oh, you’ve been chosen,'” he said. “No, it just happened. I was in the right place, probably at the right time, when it happened.”
His treatment was grueling. During his darkest hours, Castillejo considered ending his life. He went missing for four days and still has no idea what happened; he described it as “switching off” from his life.
— Londonpatient_HOPE (@londonpatient) March 9, 2020
“This is a unique position to be in, a unique and very humbling position,” he said. “I want to be an ambassador of hope.”