“ A healthy person has many hopes, a sick person has only one." , he said of his remission. A 60-year-old German patient, who wishes to remain anonymous, has just been cured of HIV, the virus that causes AIDS. This medical feat has only been accomplished six times in the past. This case was to be presented at the International AIDS Conference in Munich.
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This HIV patient also suffered from acute myeloid leukemia, a rapidly progressing cancer of the blood and bone marrow. Diagnosed with HIV in 2009, he was treated with a stem cell transplant in 2015 and was able to stop his antiretroviral (HIV) treatment in September 2018.
Since then, he has not suffered any relapse. Multiple tests have shown no trace of HIV in his body. The more time that passes without the need for HIV therapy, the more confident we are in the complete eradication of HIV." explains Christian Gaebler, HIV specialist at the hospital of Berlin Charity, where the patient was taken care of.
Atypical remission thanks to the CCR5 mutation
In the 1990s, researchers discovered that some people around the world carry the CCR5 mutation on their 3rd chromosome. A mutation that protects them from HIV. In fact, most strains of HIV attach to the CCR5 receptors and use them as a gateway into the body. When the CCR5 proteins no longer function thanks to this mutation, HIV is unable to attach to them and enter the body.
This very rare mutation is found in less than 1% of the world's population. It is especially widespread in the countries of Northern Europe, in Scandinavia. It is thanks to it that the patients in Berlin, London and Dusseldorf were able to be cured of HIV. All three also suffered from cancer, treated with a stem cell transplant. However, for these three patients, doctors managed to find donors who were not only compatible but also carriers of the CCR5-delta32 mutation.
So far, in five of the seven cases of proven remission or near-remission of HIV, donors with defects in both copies of the CCR5 gene have always been selected. This time, the selected donor had only one copy of this gene. And his immune system therefore had, a priori, only a portion of normal CCR5 proteins. And yet, this was enough to eliminate the AIDS virus from his body.
The mechanism behind this success is not yet completely clear. We now need to understand how this new immune system was able to graft itself onto the patient and how his body was able to eliminate all the HIV reservoirs over time." said Dr. Gaebler, who said he was surprised by the positive result. The patient's initial immune system may have played an important role. »
Grafting, a heavy and complicated procedure
While about 1% of the population of Northern Europe has two defective copies of the gene, about 16% have only one copy. Hence the hope raised by the remission of this new patient. This new atypical case compared to the previous ones raises the question of the factors that can guarantee the cure of HIV. “ It is likely that several factors play a role in remission.", commented the professor Sharon Lewin, president of the International AIDS Society (IAS) at a press conference. The susceptibility of T lymphocytes to be targeted by HIV for example, but also the size of the viral reservoir, the severity of the patient's disease and the individual immune response.
However, the procedure remains very cumbersome and is only suitable for people who suffer from both cancer and HIV. In addition to the side effects of these treatments, the immune system of patients is immature, like that of an infant who has never encountered any disease. It can take years to develop a mature immune system that can defend itself against a variety of infections like any adult." , explained the Dr. Jingmei Hsu, a hematologist at Langone Hospital in New York, who cared for the fourth person cured of HIV.
Graft-versus-host rejection disease, in which stem cells are not accepted by the body, can also occur. These are all risks that make this procedure a serious procedure that cannot be performed on all HIV-infected patients. This treatment carries a significant risk of fatal complications, which does not justify such measures in the context of a disease such as HIV. Especially since the latter can now be treated in the long term. With an early diagnosis of HIV, patients on antiretroviral treatment can achieve a normal life expectancy with a good quality of life." , completed the Dr. Bjorn Bjorn Jensen, an infectious disease specialist at the University Hospital of Düsseldorf, who followed the 3E patient cured of HIV.
While we wait to find out if this seventh patient confirms his remission, he has already earned a nickname. Treated in Berlin as the first patient cured of HIV, called " The Berlin Patient", this sixty-year-old nurse in the same city was baptized" Berlin's new patient. »
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