Fifth HIV Patient Cured

Nurse Beth, MSN

There seems to be a long-awaited cure for human immunodeficiency virus (HIV), the virus that causes AIDS.

While HIV has declined in the US recently, approximately 1.2 million people were living with HIV in 2021. Globally, about 38.4 million people had HIV during the same time frame. 54% were women and girls.

Treatment For HIV

HIV is a lifelong disease that destroys the immune system. Until recently, it's believed the virus never wholly disappears once contracted. Antiretroviral therapy (ART) is the treatment for HIV.

The goal of (ART) for people with HIV is to reduce the virus to almost undetectable levels and to prevent transmission. ART contains the disease but does not eradicate it.

Once the patient stops taking ART, the virus hiding in reservoirs reproduces and spreads in the body, spelling relapse.

Cautious Cure

On its website, the CDC explicitly says, "There is no cure for HIV, but you can control it with HIV treatment."

But news reports are saying differently. Some headlines use the word cure, while others cautiously say "cure" in quotes along with "virus-free" and "likely cured."

Virologist Dr. Bjorn-Erik Ole Jensen says,

Quote

It shows it's not impossible — it's just very difficult — to remove HIV from the body.”

In his article in the journal Nature Medicine Dr. Jensen qualifies his claim for the cure by saying, "strong evidence."

Stem-Cell Replacement

The cure comes from stem-cell replacement, replacing the immune system with a healthy immune system from donor cells. Specifically, donor cells with the CCR5-delta32 gene.
In contrast to ART, stem-cell replacement with this specific HIV-resistant gene eradicates HIV.

The Five Patients

In 2007, the Berlin patient, Timothy Brown, underwent a bone marrow transplant and stem-cell replacement for acute myeloid leukemia. The donor was chosen for their specific HIV-resistant genetic mutation. Timothy Brown stopped taking ART after the procedure and remained HIV-free until he died 13 yrs later from a leukemia relapse. He was the first patient cured.

City of Hope patient – A man diagnosed with HIV in 1998 was also treated for acute myeloid leukemia with a bone marrow transplant and stem cell replacement using stem cells from a donor with CCR5 delta32 genetic mutation. Afterward, the patient stopped taking ART for 14 months with no signs of returning HIV. He is the oldest person to date who has been cured.

The London patient, Adam Castillejo, was declared "likely cured" in 2019. Adam Castillejo underwent a bone marrow transplant and stem-cell replacement for Hodgkin's lymphoma. Since 2017, he has not taken ART and remains HIV-free.

The New York patient. In February 2022, a woman living with HIV, who had been treated for her acute myeloid leukemia with a blood stem-cell transplant in New York and had not been on antiretroviral therapy (ART) for 14 months, showed no signs of HIV infection. She was treated using CCR5 delta32 stem cells from cord blood combined with an adult stem cell transplant.

In 2013 the Dusseldorf patient, who is 53 years old, underwent the same procedure for acute myeloid leukemia. He stopped taking ART in 2019 and was cautiously proclaimed virus free in 2022, making him the fifth cured patient.

CCR5-delta32

CCR5-delta32 is the magic gene. Individuals must carry two copies of the gene CCR5-delta32 for HIV immunity. The gene also confers immunity to smallpox and the bubonic plague. Only 1% of the population has two copies of the gene.

In addition to HIV, all five patients had cancer. They all underwent stem-cell replacement. Stem-cell replacement is a high-risk procedure used to treat cancer and not used to cure HIV. HIV patients without leukemia/cancer will not be treated with bone-marrow transplants and stem-cell replacements.

Future Considerations

However, there is a lot to be excited about for researchers and the 38 million people living with HIV. The discovery of the CCR5-delta32 gene's HIV-resistant properties is a boon to science and brings hope for future strategies.

References

How Many Have Been Cured? | amfar.org

Living With HIV | CDC.gov

HIV / AIDS Trends and U.S. Statistics | hiv.gov

Third patient free of HIV after receiving virus-resistant cells | nature.com

In-depth virological and immunological characterization of HIV-1 cure after CCR5Δ32/Δ32 allogeneic hematopoietic stem cell transplantation | nature.com

Another Person Has Been 'Cured' of HIV, Almost a Decade After Treatment | sciencealert.com

What is CCR5 Delta32? | delta-32.com