2023-07-19 23:52:00
A man who had been living with HIV since the early 1990s is now in long remission after receiving a bone marrow transplant. An “encouraging” news, say the scientists.
A man referred to as “the Geneva patient” is in long-term HIV remission after receiving a bone marrow transplant that lacked a known mutation to block the virus, news that potentially opens up avenues for research.
His case was presented this Thursday in Brisbane, ahead of the Conference of the International AIDS Society which will open on Sunday in Australia. Before him, five people have already been considered probably cured of HIV infection after receiving a bone marrow transplant.
The cured patients all had a very particular situation in common. They were suffering from blood cancers and benefited from a stem cell transplant which deeply renewed their immune system. But each time, their donor presented a rare mutation of a gene known as CCR5 delta 32, a genetic mutation known to prevent the entry of HIV into cells.
A very special situation
For the “patient from Geneva”, the situation is different: in 2018, to treat a particularly aggressive form of leukemia, he benefited from a stem cell transplant.
But this time, the transplant came from a donor who did not carry the famous CCR5 mutation. Thus, unlike the cells of other people considered cured, those of the donor person theoretically allowed HIV to reproduce.
And yet, the virus remains undetectable 20 months after the interruption of antiretroviral treatment in this patient followed at the University Hospitals of Geneva, in collaboration with the Institut Pasteur, the Institut Cochin and the international consortium IciStem.
His antiretroviral treatment was gradually reduced and definitively stopped in November of 2021. And the analyzes carried out during the 20 months which followed the cessation of treatment detected neither viral particles, nor an activatable viral reservoir, nor an increase in immune responses against the virus in that person’s body.
The scientific teams cannot exclude that the virus still persists, but they consider that this is a new remission of the HIV infection.
The patient will have to be monitored for many months
How to explain such a phenomenon in this patient? Several hypotheses are on the table. “In this specific case, perhaps the transplant made it possible to eliminate all the infected cells without the need for the famous mutation”, suggests Asier Sáez-Cirión, head of the Viral Reservoirs and Immune Control Unit at the Institut Pasteur .
“Or maybe his immunosuppressive treatment, which was needed after the transplant, played a role,” she says.
This long remission is “encouraging” but “a single virion (an infectious viral particle, editor’s note) can cause the virus to rebound”, warned Sharon Lewin, president of the Conference of the International AIDS Society. This patient “will need to be watched closely over the next few months or even years. The likelihood of a rebound is impossible to predict,” he added.
If these remissions nourish the hope of one day overcoming HIV, a bone marrow transplant remains a very heavy and risky operation: it is not adaptable to most carriers of the virus.
The patient from Geneva, who had been living with HIV since the early 1990s, wishes to remain anonymous for the time being. “What is happening to me is magnificent, magical”, he simply reacted in a press release from the Institut Pasteur.
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