The Lancet HIV: Study suggests a second patient has been cur
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A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Lead author on the study, Professor Ravindra Kumar Gupta, University of Cambridge, UK, cautions: "It is important to note that this curative treatment is high-risk, and only used as a last resort for patients with HIV who also have life-threatening hematological malignancies. Therefore, this is not a treatment that would be offered widely to patients with HIV who are on successful antiretroviral treatment.

Their treatment included total body irradiation, two rounds of stem cell transplant from a donor who carried a gene (CCR5Δ32/Δ32) that is resistant to HIV, and a chemotherapy drug regimen. The transplant aims to make the virus unable to replicate in the patient's body by replacing the patient's immune cells with those of the donors, whilst the body irradiation and chemotherapy targets any residual HIV virus.

Results showed no active viral infection was detected in samples of the patient's blood at 30 months, or in their cerebrospinal fluid, semen, intestinal tissue, and lymphoid tissue 29 months after stopping ART.
The patient had a healthy CD4 cell count, suggesting they have recovered well from the transplant, with their CD4 cells replaced by cells derived from the HIV-resistant transplanted stem cells.

Comparing to the treatment used on the Berlin patient - the first HIV patient to be reported cured of the virus in 2011, the authors highlight that their case study of the London patient represents a step towards a less intensive treatment approach, showing that the long-term remission of HIV can be achieved using reduced-intensity drug regimens, with one stem cell transplant (rather than two) and without total body irradiation.

However, being only the second reported patient to undergo this experimental treatment successfully, the authors note that that the London patient will need to be continued, but much less frequent, monitoring for re-emergence of the virus.

Co-author on the study, says: "The London and Berlin patient are examples of using the CCR5 gene in curative therapies outside of gene editing. There are still many ethical and technical barriers - e.g. gene editing - to overcome before any approach using CCR5 gene editing can be considered as a scalable cure strategy for HIV."

Source: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(20)30069-2/fulltext
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