A 60-year-old German man appears to have been ‘cured’ of HIV in a medical milestone only achieved by six other people, doctors have announced – this after he underwent a bone marrow transplant for his leukaemia.
Primarily a cancer treatment, the bone barrow – or stem cell – transplants are risky but the man, who remains anonymous, is now clear of both diseases.
Daily Mail reports that doctors have called him the ‘next Berlin patient’ – the first being Timothy Ray Brown, who was declared cured of HIV in 2008 after the same procedure.
Brown died from cancer in 2020.
This new case was announced just before the 25th International Aids Society Conference started in Munich last week.
He was first diagnosed with HIV in 2009, and later, in 2015, received a bone marrow transplant for leukaemia. The procedure, which has a 10% risk of death, essentially replaces a person’s immune system.
The patient stopped taking anti-retroviral drugs in late 2018, and nearly six years later now appears to be both HIV and cancer free, the medical researchers said.
Christian Gaebler, a doctor-researcher at Berlin’s Charite University Hospital treating the patient, said the team cannot be “absolutely certain” every last trace of HIV has been eradicated.
But his case is “highly suggestive of an HIV cure”, said Gaebler.
International Aids Society President Sharon Lewin said researchers hesitate to use the word “cure” because it is not clear how long they need to follow up such cases.
But more than five years in remission means the man “would be close” to being considered cured, she said.
There is an important difference between the man's case and the other HIV patients who have reached long-term remission, added. All but one of the other patients received stem cells from donors with a rare mutation in which part of their CCR5 gene was missing, blocking HIV from entering their body’s cells.
Those donors had inherited two copies of the mutated CCR5 gene – one from each parent – making them “essentially immune” to HIV, Lewin said.
But the new ‘Berlin patient’ is the first to have received stem cells from a donor who had inherited only one copy of the mutated gene.
Around 15% people from European origin have one mutated copy, compared with one percent for both.
Researchers hope the latest success means there will be a much larger potential donor pool in the future. The case is also promising for the wider search for an HIV cure that works for all patients, Lewin said.
“This is because it suggests you don’t actually have to get rid of every single piece of CCR5 for gene therapy to work,” she added.
The Geneva patient, whose case was announced at last year’s Aids conference, is the other exception among the seven. He received a transplant from a donor without any CCR5 mutations, yet still achieved long-term remission.
This showed that the effectiveness of the procedure was not just down to the CCR5 gene, Lewin said.
Brown, the first patient to be “cured”, was diagnosed with HIV while studying in Berlin in 1995, and a decade later, diagnosed with leukaemia.
To treat his leukaemia, his doctor at the Free University of Berlin used a stem cell transplant from a donor who had a rare genetic mutation that gave him natural resistance to HIV, hoping it might wipe out both diseases.
It took two painful and dangerous procedures, but it was a success: in 2008 Brown was declared free of the two ailments, and was initially dubbed “the Berlin patient” at a medical conference to preserve his anonymity.
Two years later, he broke his silence and became a public figure, giving speeches and interviews and starting his own foundation.
While he remained cured of HIV, his cancer returned.
Ten years after Brown was cured, a second HIV sufferer, dubbed “the London patient”, was revealed to be in remission 19 months after undergoing a similar procedure.
The patient, Adam Castillejo, is currently HIV-free.
Other patients include a Dusseldorf patient in 2023, a New York patient in 2022, the Esperanza Patient in 2021 and Loreen Willenberg in 2020.
Unlike the other patients, in the cases of the Esperanza patient and Willenberg, their immune systems naturally rid the virus from their bodies.
Unhelpful
Most people carry the gene CCR5, but in many ways, it is incredibly unhelpful. It affects our odds of surviving and recovering from a stroke, according to recent research.
And it is the main access point for HIV to overtake our immune systems.
However, some people carry a mutation that prevents CCR5 from expressing itself, effectively blocking or eliminating the gene.
Those few people in the world are called “elite controllers” by HIV experts. They are naturally resistant to HIV.
If the virus ever entered their body, they would naturally “control” the virus as if they were taking the virus-suppressing drugs that HIV patients require.
Both the Berlin patient and the London patient received stem cells donated from people with that crucial mutation.
Why has it never worked before?
“There are many reasons this hasn’t worked,” Dr Janet Siliciano, a leading HIV researcher at the Johns Hopkins University School of Medicine, told Daily Mail. “It’s incredibly difficult to find HLA-matched bone marrow and even more difficult to find the CCR5 mutation.”
Second, there is always a risk that the bone marrow won’t “take”.
“Sometimes you don’t become fully ‘chimeric’, meaning you still have a lot of your own cells. That is one of the two most common reasons for previous attempts failing: their immune system is not fully replaced, then the cancer comes back and they can’t survive it.”
The other most common reason this approach has failed is graft-versus-host disease – when the patient’s immune system tries to attack the incoming, replacement immune system, causing a fatal reaction in most.
Interestingly, both the Berlin patient and the London patient experienced complications that are normally lethal in most other cases.
And experts believe that those complications helped their cases.
The Berlin patient had both – his cancer returned and he developed graft-versus-host disease, putting him in a coma and requiring a second bone marrow transplant.
The London patient had one: he suffered graft-versus-host disease.
Against the odds, they both survived, HIV-free.
Some believe that, ironically, graft-versus-host disease might have helped both of them to further obliterate their HIV. But there is no way to control or replicate that safely
See more from MedicalBrief archives:
‘London Patient’ steps out of the shadows
‘Geneva’ HIV patient possibly cured in new case
UK man the second to be cleared of the Aids virus
Third patient HIV-free after virus-resistant cell transplant
Fourth person cured of HIV, fifth success in the wings: AIDS 2022 conference