Unique stem cell transplant puts HIV patient in remission: Why it could be the path to a cure

A German HIV patient who is in remission after receiving a stem cell transplant from a donor who partially carries an HIV resistance gene is giving researchers new hope that more people could benefit from the treatment.

The first step in a stem cell transplant for a cancer patient is to wipe out the patient's immune cells with chemotherapy. If the patient is also infected with HIV, these cells can be replaced with a stem cell transplant from a rare individual who carries a gene that essentially gives them immunity to the virus that causes AIDS. Only a handful of people worldwide are eligible for this procedure, as they must be infected with both HIV and cancer.

According to a study published by Christian Gaebler of the University of Berlin's School of Medicine, the German HIV patient was treated for acute myeloid leukemia with a stem cell transplant in 2015. He stopped taking antiretroviral drugs in 2018 and the virus is in remission. He is one of only seven people to have achieved HIV remission between 2007 and 2023.

In most of these cases, stem cell donors naturally inherit two copies of a gene called CCR5 delta 32, which confers HIV resistance. The German patient is the first known case in which a stem cell donor inherited only one copy of the CCR5 delta 32 gene, according to Gaebler and his co-authors. The study has not yet been peer-reviewed.

The researchers on Thursday Virtual Announcement The research, which will be presented at the 25th International AIDS Conference in Munich, Germany, could pave the way for more people to receive treatment and have promising implications for future HIV treatment strategies.

“To me, the hope is that a cure will be found, and this case proves that,” Sharon Lewin, president of the International AIDS Society (IAS), told reporters.

However, the reality is that rare.

This case could help develop new treatments

Gaebler said that in September, a German HIV patient will have been in remission for six years — a length of time that gives researchers confidence in their observations.

“A healthy person has many wishes, but a sick person has only one,” the anonymous patient said in a statement from the IAS on Thursday.

Dr. Marina Klein, a professor of medicine at McGill University in Montreal, said the man's case could help develop new treatments.

“This case shows that you don't actually need 100% of the cells to get complete resistance,” said Klein, who was not involved in the study.

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According to the study: One percent About 20 percent of white people have been measured to have two copies of the resistance gene, and about 20 percent have one copy. HIV experts say that while people with one copy of the gene have a slower progression of the virus without antiretroviral treatment, people with two copies seem to be able to suppress the virus completely.

IAS president Lewin said the German patient's experience “suggests that we could expand the donor pool in these types of cases.”

The researchers also hope that this study will have promising implications for more scalable HIV treatment strategies in the future.

Klein, who heads Canada's HIV Clinical Trials Network, noted that HIV diagnoses increased by about 25 per cent from 2021 to 2022. This makes the goal of eliminating the disease even more difficult to achieve, she said.

“People get frustrated at times, but it's these little learnings that ultimately put us on the path to healing,” she said.

Availability, cost-effectiveness questions

Eric Aerts, a professor of microbiology and immunology at Western University, is researching ways to control HIV.

While it's encouraging that patients no longer need to take medication to suppress their HIV, Aerts said there are challenges to scaling up the treatment to make it available to other patients.

“The actual solutions that are being used to treat leukemia are not solutions for HIV,” Aerts said. [HIV] To address the pandemic as a whole, we need to make it available to everyone.”

Aerts said people with HIV can live normal lives with antiretroviral treatment, so the poor survival rates and costs of stem cell transplants cannot be justified for them compared with leukemia patients who have no other options.

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Réjean Thomas, an HIV expert and co-founder of the medical clinic Lacouture, said the rise in HIV cases could be because people are visiting doctors less during the pandemic.

As a person with HIV, Jean-Paul Michael manages his disease with antiretroviral drugs, but when he was first diagnosed, he had no money to buy the medicine.

He had been injecting crystal meth for years, but when he began receiving treatment for AIDS-related pneumonia in an intensive care unit eight years ago, a housing stabilization worker told him Affordable Housing And the tools to rebuild your life.

Stigma around HIV remains very prevalent and “when people hear it, there's a lot of backlash,” said Michael, who now works as an addiction case manager in the emergency department at St. Michael's Hospital in Toronto.

Both Michael and Klein called for antiretroviral drugs to be made available to everyone.

“If we could teach the immune system how to deal with this virus without drugs, that would be a major breakthrough,” Klein said.