Infectious diseases: HIV-1 remission achieved in second patient

The second recorded case of a patient experiencing remission from HIV-1 infection after stem-cell transplantation is reported in a paper published this week in Nature. Although the patient has so far been in remission for 18 months, the authors caution that it is too early to say that the patient is ‘cured’ of HIV.

There has only been one documented case in which a patient has been cured of HIV after receiving a transplant of haematopoietic stem cells from a donor with two copies of the Δ32 mutation of CCR5. CCR5 is a co-receptor for HIV-1 infection, and homozygous carriers of this mutation are resistant to infection with HIV-1 viruses that use this co-receptor. This previous case, known as the ‘Berlin patient’, occurred 10 years ago, but the treatment was very aggressive and the approach has not been successfully repeated until now.

Ravindra Gupta and colleagues demonstrated the effectiveness of a less aggressive form of this treatment in a patient with HIV-1 who was diagnosed with advanced Hodgkin’s lymphoma in 2012. To treat the cancer, the patient received a transplant of haematopoietic stem cells from a donor with two copies of the CCR5 Δ32 allele. The patient experienced only a mild reaction to the stem-cell transplant. The authors report that the patient became homozygous for CCR5 Δ32 after transplantation, and anti-retroviral therapy was interrupted after 16 months. The authors confirmed that HIV-1 RNA was undetectable, and the patient has remained in remission for an additional 18 months.

These findings demonstrate that the ‘Berlin patient’ was not an anomaly and provide further support for the development of approaches that target CCR5 as a strategy for HIV remission.

doi: 10.1038/s41586-019-1027-4

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