Second patient with HIV has reached remission
The second patient with HIV-1 has sustained remission after stopping treatment. This is stated in the report of scientists from University College and Imperial College London.
The case report, described in the scientific journal Nature, was released 10 years after the first clinical case of this kind, known as the “Berlin patient”. The publication was attended by colleagues from the University of Cambridge and Oxford.
In both cases, the patient was transplanted stem cells from donors with a mutation of the CCR5 gene, immune to HIV.
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In the new study, the patient is in remission 18 months after discontinuation of antiretroviral therapy (ART). The report's authors believe that it is still too early to speak with certainty about complete healing. They will continue to monitor the patient's condition.
“Currently, the only way to treat HIV is virus suppressing drugs that have to be taken for life, which causes certain difficulties in developing countries,” said the lead author of the study, Professor Ravindra Gupta. - Search for a way that will destroy the virus once and for all - the primary task of the international scale, which requires an immediate solution. It is extremely difficult to find it, because the virus penetrates into the carrier’s white blood cells. ”
Worldwide, nearly 37 million people live with HIV, but only 59% are on ART. Also of concern is the increased resistance of HIV to the effects of drugs. Every year, for reasons related to HIV, about 1 million people die.
The report describes a male patient from the UK who chose to remain anonymous. He was diagnosed with HIV in 2003, and since 2012 he has been on antiretroviral therapy.
Later in 2012, he was diagnosed with Hodgkin's lymphoma in a progressive stage. In addition to chemotherapy, in 2016, he underwent a hematopoietic stem cell transplant from a donor with two copies of the CCR5-Δ32 gene.
CCR5 is the most commonly used receptor for HIV-1. People with two copies of the CCR5 mutation are immune to HIV-1 receptor using this receptor, since the virus cannot enter the cell.
Chemotherapy can successfully fight HIV by killing dividing cells. Replacing immune cells with those that do not have a CCR5 receptor may be the key to preventing the recurrence of HIV symptoms after treatment.
The transplantation took place without serious complications, but with some side effects, including a mild graft-versus-host reaction - a complication of a transplant, when donor immune cells attack the immune cells of the recipient.
After transplantation, the patient underwent antiretroviral therapy for another 16 months, after which the joint decision of the patient and the doctors stopped the treatment in order to find out whether the patient with HIV is in remission.
Analyzes showed a constant absence of virus concentration in the patient’s blood. He is in remission for 18 months after stopping treatment (35 months after transplantation). Its immune cells do not produce the CCR5 receptor.
This is the second recorded case of sustained remission without ART. In the first "Berlin patient", stem cells were also transplanted from a donor with a mutation CCR5-Δ32, but only for the treatment of leukemia. The main difference between the “Berlin patient” is that he had two transplants and total body irradiation, while the “London patient” underwent only one transplant and less intensive chemotherapy.
Both patients experienced a mild graft versus host reaction, which could also play a role in the death of HIV-infected cells.
“Having managed to achieve remission in the second patient thanks to a similar approach, we showed that the“ Berlin patient ”was not an anomaly, namely the chosen treatment method saved two people from HIV,” said Professor Gupta.
Scientists warn that such a method cannot be taken as the standard for treating HIV due to the toxic effects of chemotherapy, but it does hope that a new treatment strategy will emerge that will finally defeat HIV.
“We are continuing research to see if we can disable this receptor in people with HIV, which is quite possible with gene therapy,” said Professor Gupta.
“The treatment we applied is different from what the Berlin patient went through because we did not use radiation therapy. Its success indicates the importance of developing a new strategy based on inhibiting the expression of the CCR5 gene, ”said study co-author Dr. Jen Gabriel.
“It is too early to say that our patient is completely cured of HIV. Doctors will continue to monitor his condition. The apparent success of the hematopoietic stem cell transplant allows us to hope that the long-awaited cure for HIV / AIDS will be found, ”said Professor Eduardo OlavarrĂa.
Photo by C. Goldsmith
The case report, described in the scientific journal Nature, was released 10 years after the first clinical case of this kind, known as the “Berlin patient”. The publication was attended by colleagues from the University of Cambridge and Oxford.
In both cases, the patient was transplanted stem cells from donors with a mutation of the CCR5 gene, immune to HIV.
')
In the new study, the patient is in remission 18 months after discontinuation of antiretroviral therapy (ART). The report's authors believe that it is still too early to speak with certainty about complete healing. They will continue to monitor the patient's condition.
“Currently, the only way to treat HIV is virus suppressing drugs that have to be taken for life, which causes certain difficulties in developing countries,” said the lead author of the study, Professor Ravindra Gupta. - Search for a way that will destroy the virus once and for all - the primary task of the international scale, which requires an immediate solution. It is extremely difficult to find it, because the virus penetrates into the carrier’s white blood cells. ”
Worldwide, nearly 37 million people live with HIV, but only 59% are on ART. Also of concern is the increased resistance of HIV to the effects of drugs. Every year, for reasons related to HIV, about 1 million people die.
The report describes a male patient from the UK who chose to remain anonymous. He was diagnosed with HIV in 2003, and since 2012 he has been on antiretroviral therapy.
Later in 2012, he was diagnosed with Hodgkin's lymphoma in a progressive stage. In addition to chemotherapy, in 2016, he underwent a hematopoietic stem cell transplant from a donor with two copies of the CCR5-Δ32 gene.
CCR5 is the most commonly used receptor for HIV-1. People with two copies of the CCR5 mutation are immune to HIV-1 receptor using this receptor, since the virus cannot enter the cell.
Chemotherapy can successfully fight HIV by killing dividing cells. Replacing immune cells with those that do not have a CCR5 receptor may be the key to preventing the recurrence of HIV symptoms after treatment.
The transplantation took place without serious complications, but with some side effects, including a mild graft-versus-host reaction - a complication of a transplant, when donor immune cells attack the immune cells of the recipient.
After transplantation, the patient underwent antiretroviral therapy for another 16 months, after which the joint decision of the patient and the doctors stopped the treatment in order to find out whether the patient with HIV is in remission.
Analyzes showed a constant absence of virus concentration in the patient’s blood. He is in remission for 18 months after stopping treatment (35 months after transplantation). Its immune cells do not produce the CCR5 receptor.
This is the second recorded case of sustained remission without ART. In the first "Berlin patient", stem cells were also transplanted from a donor with a mutation CCR5-Δ32, but only for the treatment of leukemia. The main difference between the “Berlin patient” is that he had two transplants and total body irradiation, while the “London patient” underwent only one transplant and less intensive chemotherapy.
Both patients experienced a mild graft versus host reaction, which could also play a role in the death of HIV-infected cells.
“Having managed to achieve remission in the second patient thanks to a similar approach, we showed that the“ Berlin patient ”was not an anomaly, namely the chosen treatment method saved two people from HIV,” said Professor Gupta.
Scientists warn that such a method cannot be taken as the standard for treating HIV due to the toxic effects of chemotherapy, but it does hope that a new treatment strategy will emerge that will finally defeat HIV.
“We are continuing research to see if we can disable this receptor in people with HIV, which is quite possible with gene therapy,” said Professor Gupta.
“The treatment we applied is different from what the Berlin patient went through because we did not use radiation therapy. Its success indicates the importance of developing a new strategy based on inhibiting the expression of the CCR5 gene, ”said study co-author Dr. Jen Gabriel.
“It is too early to say that our patient is completely cured of HIV. Doctors will continue to monitor his condition. The apparent success of the hematopoietic stem cell transplant allows us to hope that the long-awaited cure for HIV / AIDS will be found, ”said Professor Eduardo OlavarrĂa.
Photo by C. Goldsmith
Source: https://habr.com/ru/post/443056/
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