Stem cell transplants are not being proposed as treatments for HIV, but this case and a handful of others offer promising confirmation that HIV is not entirely incurable.
In Germany, a now-53-year-old man who was diagnosed with HIV learned he was virus-free receiving HIV-resistant stem cells through a bone marrow transplant that was intended to treat leukemia.
The patient was diagnosed to be HIV-1 clade B positive in January 2008 and presented with a CD4+ T cell count of 964 cells per μl and an HIV-1 plasma viral load of 12,850 copies per ml.
The individual underwent a transplant in 2013, and was monitored for the ensuing nine years, and there’s strong evidence that he has been cured.
The man was part of a study by a team at University Hospital Düsseldorf, led by Björn-Erik Ole Jensen, which destroyed the patient’s cancerous bone marrow cells and replaced them with donor cells that lack CCR5, the receptor that HIV particles use to infect cells.
The individual was enrolled as patient no. 19 in the study. Over a period of five years, the research team collected tissue and blood samples from the patient, and continued to find immune cells that specifically reacted to HIV, which suggested that a reservoir remained somewhere in the man’s body.
Jensen and his colleagues noted in their report on this case that was published in Nature Medicine in February that wasn’t clear if these immune cells had targeted active virus particles or a graveyard of viral remnants. The study authors also discovered HIV DNA and RNA in the patient’s body, but those never seemed to replicate.
According Jensen and his colleagues, once the patient went off antiretroviral therapy, he remained free of HIV.
The treatment is not intended for noncancer patients due to its high risks, according to the authors. It does, though, offer promising confirmation that HIV is not entirely incurable. What’s more, the research provides some hope for a future without daily medical treatment for those with HIV and underscores the potential for other research pursuing a cure.
The Dusseldorf patient is one of a small number of patients who have received this treatment effectively, including Timothy Ray Brown, a Berlin man who had a bone marrow transplant to treat leukemia in 2007, and Adam Castillejo, a Londoner who was declared free of HIV in 2019. It’s believed that a handful of others have also seen such positive results.
The German man, who wished to remain anonymous, said in a statement that the bone marrow transplant had been a “very rocky road,” and he planned to devote some of his life to supporting research fundraising going forward.
Jensen and his research team have transplants for several other people affected by both HIV and cancer, but it’s early in the process to determine if there will be similar results. His team plans to study whether if a person has a larger reservoir of HIV at the time of receiving a transplant if it affects how well the immune system recovers and eliminates any remaining viruses from the body.