A Potential Sixth Person Could Join the Club of HIV Remission and Possible Cure

 Stem Cell Transplant for Cancer Treatment: Unique Case Raises Hope for HIV Remission

European Man in HIV Remission After Stem Cell Transplant for Blood Cancer

A European man has achieved a state of remission from HIV infection for nearly two years following a stem cell transplant to treat blood cancer. If he continues to show no signs of viable virus, he may become the sixth person to be considered either definitely or possibly cured of HIV.

All six individuals underwent stem cell transplants for blood cancers like leukemia or lymphoma while living with HIV. However, this unique case involves a person whose stem cell donor did not possess the rare genetic abnormality that creates resistance to HIV in the immune cells targeted by the virus for infection.

The man's case will be presented at the International AIDS Society Conference on HIV Science in Brisbane, Australia. This significant biennial scientific gathering will also feature presentations on post-treatment control of HIV in infant boys, the impact of circumcision on HIV risk in gay men, and the relationship between HIV and mpox (formerly known as monkeypox).

It is important to note that it remains unethical for individuals with HIV who do not qualify for a stem cell transplant due to cancer to undergo such treatment in the hope of curing the virus, given its considerable toxicity. Scientists generally anticipate that any progress in developing a widely scalable HIV cure therapy will likely take decades.

Despite this, Dr. Sharon Lewin, president of the IAS and director of the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia, hailed the new viral remission case as "great news." Such case reports play a crucial role in advancing the work toward finding a cure for HIV.

The 'Geneva Patient' 

The Geneva Patient: A Remarkable Case of HIV Remission

The man who has recently achieved remission from HIV has been nicknamed the Geneva Patient, in reference to the Swiss city where he received his treatment. In his early 50s, he was diagnosed with HIV in 1990 and began antiretroviral treatment in 2005. In 2018, he was diagnosed with a rare blood cancer called extramedullary myeloid tumor and underwent radiation, chemotherapy, and a stem cell transplant.

His case has been closely monitored by a research team led by Asier Sáez-Cirión, head of the viral reservoirs and immune control unit at the Institut Pasteur in Paris.

HIV is notoriously difficult to cure because the virus remains hidden in non-replicating immune cells known as the viral reservoir, even when suppressed by antiretroviral drugs. Standard HIV treatment targets actively producing viral copies, leaving the virus undetected within these latently infected cells, which can take months or even years to start replicating again.

Since the first reported case in 2008, three people have been definitively cured of HIV, and two others may be considered cured pending further time without viral rebound.

Before the Geneva Patient's case, a few individuals with HIV and cancer had received stem cell transplants from donors lacking the rare genetic mutation that confers natural resistance to the virus. However, none from this group went more than 10 months without a resurgence of the virus after stopping antiretroviral treatment, leading to dashed hopes of a cure.

The Geneva Patient has now spent 20 months without viral rebound since stopping antiretrovirals in November 2021. Extensive ultrasensitive tests have only detected trace amounts of defective virus in his body. Nevertheless, it cannot be ruled out that he may still harbor a single cell infected with viable virus that could potentially reinitiate HIV replication.

The reasons behind the Geneva Patient's successful remission remain unclear, as others who underwent similar treatments were not as fortunate. Dr. Steven Deeks, a prominent HIV cure researcher at the University of California, San Francisco, speculates that the chemotherapy played a crucial role in eliminating most of the viral reservoir. Additionally, the patient's repeated episodes of graft-versus-host disease, a potent immune reaction following a stem cell transplant, might have contributed to clearing the old immune system, including any residual T cells harboring HIV.

Sáez-Cirión also considers the possibility that the immunosuppressive drugs the patient continues to receive to prevent graft-versus-host disease may be preventing any remaining HIV from replicating. The case offers hope for the possibility of achieving remission from HIV, challenging previous assumptions about its feasibility. Nonetheless, researchers remain cautious and acknowledge that further research and time are required to fully understand and potentially replicate these remarkable results.

Post-Treatment Control of HIV: Exploring Remission and Potential Cure

In sub-Saharan Africa, researchers have identified a small group of boys who were born with HIV and remarkably did not experience viral rebound even after their antiretroviral treatment was interrupted for prolonged periods.