Complete cure of HIV: a 3rd case

Complete cure; of HIV: a 3rd case

For the third time in history, a patient has been declared “ HIV-free ”: in other words, completely rid of this virus responsible for AIDS which, in general, has a tendency to remain “dormant” indefinitely”. 

Since the development of so-called antiretroviral treatments in the late 1980s, the objective has been to reduce the virus to to undetectable levels in the hope that it can no longer be transmitted to other people. But the virus remained somehow “ locked ” in reservoirs inside the body, ready to reappear the moment the patient stopped treatment. 

However, a 53-year-old man in Germany apparently owes his luck to a bone marrow transplant whose donor carried a mutation, called CCR5 delta32: this makes those who are carriers (less than 1% of the population) resistant to HIV. The virus, which uses the CCR5 receptor to enter cells, is unable to do so with this mutation. The “ Düsseldorf patient ”, as he is called, “ inherited ” the mutation at the same time as the transplant. 

But the process has been so long and complex that researchers do not yet see how it could be replicated on a large scale. Diagnosed with HIV in 2008, the patient developed leukemia in 2011, first underwent chemotherapy then was able to benefit from this transplant in 2013, and was finally able to take the risk, in 2018, of interrupting antiretrovirals. Four years later, the virus has not reappeared.

It is the same technique that was used in the “ Berlin patient ”, Timothy Ray Brown, in 2007, and in the Briton Adam Castillejo, whose existence was revealed in 2019. To date, these are the two only other patients officially diagnosed as having been cleared of their HIV reservoirs. A New Yorker was also mentioned in 2022, “ HIV-free ” for 14 months at that time, a period however considered too short to declare him “cured”. 

If it is certain that the cells carrying the mutation played a decisive role, the experts in the field commented with many reservations on the research published on February 20 on this patient from Düsseldorf. Perhaps his chemotherapy contributed to the success, by preventing some infected cells from reproducing. And either way, the risks of rejection in bone marrow transplants are high, making it hard to imagine offering them to those who don't have leukemia. 

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