The IciStem consortium, coordinated by IrisCaixa, has presented the third case of HIV cure in the world. This is what is known as the Düsseldorf patient, a man who, after receiving a stem cell transplant against myeloid leukemia and interrupting antiretroviral treatment, has been free of the virus in his body for four years.
The magazine Nature Medicine has confirmed the patient’s cure, since for 44 months no HIV virus with replication capacity or immune response associated with viremia has been detected, as he explains the IGTP researcher (Germans Trias Research Institute) at IrsiCaixa and co-author of the study, María Salgado.
This evidence has allowed the research team to consider the Düsseldorf patient to be a new case of cure. The third in the world after the confirmation of the Berlin and London patients.
The study was carried out by the international consortium IciStem, coordinated by the IrsiCaixa AIDS Research Institute – a center promoted jointly by the “la Caixa” Foundation and the Department of Health of the Generalitat de Catalunya – and the University Medical Center of Utrecht (Netherlands).
The story of the Düsseldorf patient
In 2008, a medical team from Düsseldorf diagnosed HIV infection in a person who, later on, would be known as the Düsseldorf patient, due to his uniqueness, as IrsiCaixa recalls in a statement.
The man began treatment against the virus, which allowed him to control the infection and reduce the viral load to undetectable in the blood.
Four years later, already in 2012, he had leukemia – cancer in the cells of the immune system – and they had to do a stem cell transplant. In such unique cases as in this patient, a donor of cells with the CCR5Δ32 mutation was sought.
And why this mutation?
This genetic alteration closes the entrance doors of HIV into the cells and thus makes it resistant to infection.
The matching of all these factors “is very complicated”, according to Salgado, since only 1% of the population has this mutation and, in addition, it must be compatible to avoid rejection of the transplant.
It was a woman, in this case, the donor.
53 years old and in good health
Five years after the transplant, several relapses of the leukemia and various complications, the Düsseldorf patient stabilized.
From that moment, the research team agreed to withdraw the antiretroviral treatment against HIV.
The man is currently 53 years old and in good health.
“When he stopped taking the treatment, we followed him for 44 months and we did not detect any traces of the virus in the patient’s blood or tissues,” says Salgado, who points out that they also did not see an immune response characteristic of a resurgence of the virus.
“Their defenses are not activated against HIV because they don’t have to defend themselves against the virus,” he explains.
Therefore, the scientific team verifies that the patient has been cured of HIV infection.
Scientific hope to fight HIV
The Düsseldorf patient, together with the one from Berlin, which was the first, and the one from London, are the only three cases in which we can talk about a cure, although the HIV remission of two patients has already been presented at scientific conferences more: that of New York and that of the City of Hope Hospital located in Duarte.
Salgado points out that no one has special immune characteristics that allow them to control the HIV infection spontaneously, “but that the virus has been removed from the body as a result of a medical intervention”.
“This differentiates these cases of eradication from those of functional cure in elite controllers or post-treatment achieved so far, where the people’s own body had special factors that allowed them to control the virus”, adds the researcher.
This third patient is a third proof of concept that shows that there is a possibility of curing HIV and ignites, once again, the hope of the scientific world that is dedicated to fighting this virus, according to IrsiCaixa.
Aggressive strategy
However, the one used in these cases is a “very aggressive” strategy that cannot be carried out in the rest of the population. Stem cell transplantation is only applied to people who suffer from a hematological disease and have no therapeutic alternative.
A possible strategy that is already being worked on, as explained by the co-author of the study, Javier Martínez-Picado, is to “introduce the CCR5Δ32 mutation through gene therapy to achieve a cure for HIV without having to go through a transplant”.
Martínez-Picado, researcher ICREA (Catalan Institute of Research and Advanced Studies) at IrsiCaixa and co-director of the international consortium IciStem, emphasizes that together with an “excellent team of professionals all over the world”, they have been studying exceptional cases in that thanks to a therapeutic strategy, the virus is completely eliminated from the body.
“We want to understand in detail each step of the healing process to be able to design strategies that are replicable to the entire population,” adds the researcher.