In DepthInfectious Diseases

Has a second person with HIV been cured?

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Science  08 Mar 2019:
Vol. 363, Issue 6431, pp. 1021
DOI: 10.1126/science.363.6431.1021

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Since the AIDS epidemic surfaced in 1980, some 75 million people have been infected with HIV and only one person has been cured, Timothy Ray Brown, aka the "Berlin patient." Now, a second infected person, who received a similar intervention to Brown, also appears to have cleared his infection. Both Brown and a man dubbed "the London patient" had blood cancers that required stem cell transplants. At the advice of their doctors, they received transplants from immunologically matched donors who also happened to have mutations in CCR5, a receptor on white blood cells that HIV uses to establish infections. The transplants may have also helped rid their bodies of HIV because they required "conditioning" regimens of toxic chemicals—and in the case of Brown, whole body irradiation, too—to kill off their tumor cells. What's more, they both had graft-versus-host disease in which the donor immune cells attack the recipient's tissues as foreign, which further could have killed residual HIV. As the London patient's doctor explained at an AIDS conference in Seattle, Washington, this week and in a description of the case in Nature, the man (who wants to remain anonymous) has been off anti-HIV drugs for 18 months and has no detectable virus in his blood on the most sensitive assays. The researchers studying him are being cautious and saying he is in long-term remission, not cured—and indeed the virus has rebounded in others who looked cured but many months later had HIV resurface. The intensive intervention also will only make sense for HIV-infected people with blood cancers, a tiny fraction of the 37 million people living with the virus today. But there's hope that if both men indeed are cured it will spur simpler interventions that genetically modify CCR5, some of which are being studied today.