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4 months ago
23
A 60-year-old German man has likely been 'cured' of HIV, in a medical milestone only achieved by six other people, doctors have announced.
The man is believed the have undergone a stem cell transplant, once known as a bone marrow transplant, after he developed leukaemia, a type of blood cancer.
Primarily a cancer treatment, stem cell transplants are risky but the man, who remains anonymous, is now clear of both diseases.
His doctors dubbed him the 'next Berlin patient' — the first being Timothy Ray Brown, who was declared cured of HIV back in 2008 after the same procedure.
Brown died from cancer in 2020. This new case was announced ahead of the 25th International AIDS Conference being held in the German city of Munich next week.
Timothy Ray Brown with his dog, Jack, on Treasure Island in San Francisco in 2011. Brown, who was known for years as the Berlin patient, had a transplant in Germany from a donor with natural resistance to the AIDS virus. It was thought to have cured Brown's leukemia and HIV
The latest UKHSA data shows HIV diagnoses increased by 22 per cent — from 3,118 in 2021 to 3,805 in 2022
He was first diagnosed with HIV in 2009, according to the research abstract being presented at the conference.
What is HIV?
HIV damages the cells in the immune system and weakens the body's ability to fight every day infections and disease.
The virus is spread through the bodily fluids — such as semen, vaginal and anal fluids, blood and breast milk — of an infected person. However, it cannot be spread through sweat, saliva or urine.
It is most commonly transmitted through having condom-less anal or vaginal sex.
Tests are the only way to detect HIV. They are available from GPs, sexual health clinics, some charities and online and involve taking a sample of saliva or blood.
A preventative HIV medication, pre-exposure prophylaxis (PrEP), can also be prescribed to over-16s. It slashes the risk of contracting HIV, if it is taken correctly.
Those who take post-exposure prophylaxis (PEP) — an anti-HIV medicine — within 72 hours of exposure may avoid becoming infected at all.
For those who are infected, no cure is available for HIV.
But antiretroviral therapy (ART) — which stops the virus replicating in the body, allowing the immune system to repair itself — enable most to live a healthy life.
The man received a bone marrow transplant for his leukaemia in 2015. The procedure, which has a 10 per cent risk of death, essentially replaces a person's immune system.
Then he stopped taking anti-retroviral drugs — which reduce the amount of HIV in the blood — in late 2018.
Nearly six years later, he appears to be both HIV and cancer free, the medical researchers said.
Christian Gaebler, a doctor-researcher at Berlin's Charite university hospital treating the patient, said the team cannot be 'absolutely certain' every last trace of HIV has been eradicated.
But 'the patient's case is highly suggestive of an HIV cure,' Gaebler added.
'He feels well and is enthusiastic about contributing to our research efforts.'
It's estimated that there are 105,200 people living with HIV in the UK, according to National AIDS Trust.
But only 94 per cent of these people are diagnosed.
This means that around 1 in 16 people living with HIV in the UK do not know that they have the virus.
International AIDS Society President Sharon Lewin said researchers hesitate to use the word 'cure' because it is not clear how long they need to follow up such cases.
But more than five years in remission means the man 'would be close' to being considered cured, she told a press conference.
There is an important difference between the man's case and the other HIV patients who have reached long-term remission, she said.
All but one of the other patients received stem cells from donors with a rare mutation in which part of their CCR5 gene was missing, blocking HIV from entering their body's cells.
Those donors had inherited two copies of the mutated CCR5 gene — one from each parent — making them 'essentially immune' to HIV, Lewin said.
But the new Berlin patient is the first to have received stem cells from a donor who had inherited only one copy of the mutated gene.
Around 15 per cent of people from European origin have one mutated copy, compared to one percent for both.
It's estimated that there are 105,200 people living with HIV in the UK, according to National AIDS Trust (stock)
Timothy Ray Brown poses for a photograph, Monday, March 4, 2019, in Seattle. Brown, also known as the 'Berlin patient,' was the first person to be cured of HIV infection
Researchers hope the latest success means there will be a much larger potential donor pool in the future.
The new case is also 'promising' for the wider search for an HIV cure that works for all patients, Lewin said.
This is 'because it suggests that you don't actually have to get rid of every single piece of CCR5 for gene therapy to work,' she added.
The Geneva patient, whose case was announced at last year's AIDS conference, is the other exception among the seven. He received a transplant from a donor without any CCR5 mutations — yet still achieved long-term remission.
This showed that the effectiveness of the procedure was not just down to the CCR5 gene, Lewin said.
Mr Brown, the first patient to be 'cured', was diagnosed with HIV while was studying in Berlin in 1995.
A decade later, he was diagnosed with leukaemia, a cancer that affects the blood and bone marrow.
Acute myeloid leukaemia is the most common type among adults, with around 3,000 Brits and 20,000 Americans diagnosed each year.
It is also the deadliest, claiming 2,700 lives in the UK and 11,000 in the US annually.
To treat his leukaemia, his doctor at the Free University of Berlin used a stem cell transplant from a donor who had a rare genetic mutation that gave him natural resistance to HIV, hoping it may wipe out both diseases.
It took two painful and dangerous procedures, but it was a success: in 2008 Brown was declared free of the two ailments, and was initially dubbed 'the Berlin Patient' at a medical conference to preserve his anonymity.
Two years later, he decided to break his silence and went on to become a public figure, giving speeches and interviews and starting his own foundation.
'I am living proof that there could be a cure for AIDS,' he told AFP in 2012. 'It's very wonderful, being cured of HIV.'
While he remained cured of HIV, his cancer returned.
Ten years after Brown was cured, a second HIV sufferer — dubbed 'the London Patient' — was revealed to be in remission 19 months after undergoing a similar procedure.
The patient, Adam Castillejo, is currently HIV-free.
Other patients include a Dusseldorf patient in 2023, a New York Patient in 2022, the Esperanza Patient in 2021 and Loreen Willenberg in 2020.
Unlike the other patients, in the cases of the Esperanza Patient and Ms Willenberg, their immune systems naturally rid the virus from their bodies.
HOW A STEM CELL TRANSPLANT CURED THE BERLIN PATIENT AND THE LONDON PATIENT
The vast majority of humans carry the gene CCR5.
In many ways, it is incredibly unhelpful.
It affects our odds of surviving and recovering from a stroke, according to recent research.
And it is the main access point for HIV to overtake our immune systems.
But some people carry a mutations that prevents CCR5 from expressing itself, effectively blocking or eliminating the gene.
Those few people in the world are called 'elite controllers' by HIV experts. They are naturally resistant to HIV.
If the virus ever entered their body, they would naturally 'control' the virus as if they were taking the virus-suppressing drugs that HIV patients require.
Both the Berlin patient and the London patient received stem cells donated from people with that crucial mutation.
WHY HAS IT NEVER WORKED BEFORE?
'There are many reasons this hasn't worked,' Dr Janet Siliciano, a leading HIV researcher at the Johns Hopkins University School of Medicine, told DailyMail.com.
1. FINDING DONORS
'It's incredibly difficult to find HLA-matched bone marrow [i.e. someone with the same proteins in their blood as you],' Dr Siliciano said.
'It's even more difficult to find the CCR5 mutation.'
2. INEFFECTIVE TRANSPLANT LEADS TO CANCER RELAPSE
Second, there is always a risk that the bone marrow won't 'take'.
'Sometimes you don't become fully "chimeric", meaning you still have a lot of your own cells.'
That is one of the two most common reasons for previous attempts failing: their immune system is not fully replaced, then the cancer comes back and they can't survive it.
3. GRAFT-VERSUS-HOST DISEASE: THE OLD IMMUNE SYSTEM ATTACKS THE NEW ONE
The other most common reason this approach has failed is graft-versus-host disease.
That is when the patient's immune system tries to attack the incoming, replacement immune system, causing a fatal reaction in most.
4. UNKNOWN QUANTITIES
Interestingly, both the Berlin patient and the London patient experienced complications that are normally lethal in most other cases.
And experts believe that those complications helped their cases.
Timothy Ray Brown, the Berlin patient, had both - his cancer returned and he developed graft-versus-host disease, putting him in a coma and requiring a second bone marrow transplant.
The London patient had one: he suffered graft-versus-host disease.
Against the odds, they both survived, HIV-free.
Some believe that, ironically, graft-versus-host disease might have helped both of them to further obliterate their HIV.
But there is no way to control or replicate that safely.
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