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The next Berlin patient: sustained HIV remission surpassing five years without antiretroviral therapy after heterozygous CCR5 WT/Δ32 allogeneic hematopoietic stem cell transplantation
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The "next Berlin Patient" appears cured of HIV following stem cell transplant; case is first of its kind
Christian Gaebler of Charité - Universitätsmedizin Berlin presented a study on the "next Berlin Patient", an adult male who appears to be the world's seventh person cured of HIV following a stem cell transplant. Importantly, this appears to be the first HIV cure case in which the stem cell donor had a single, rather than double, CCR5-delta32 mutation - a fact that could have promising implications for future, more scalable HIV cure strategies.
The "next Berlin Patient" had both leukaemia and HIV. He received a stem cell transplant for leukaemia in late 2015; then, in late 2018, he stopped taking antiretroviral treatment for HIV. About five-and-a-half years later, he remains in HIV remission.
"A healthy person has many wishes, a sick person only one," said the next Berlin Patient, who has chosen to remain anonymous.
Any case of sustained HIV remission without antiretroviral treatment is noteworthy. But in most HIV cure cases following stem cell transplants, the donors had naturally inherited two copies of the CCR5-delta32 mutation - one from each parent. Also known as homozygous, these individuals are essentially immune to HIV.
This is the first HIV cure case in which the donor had inherited just one copy of the CCR5-delta32 mutation - known as heterozygous. These individuals can acquire HIV, but the virus generally progresses slowly if they do not receive antiretroviral treatment. Significantly more people have the heterozygous mutation than the homozygous mutation.
The study concludes that "effective reservoir reductions, durable HIV remission and potential cure can be achieved with functional viral co-receptors, suggesting that allogeneic immunity fundamentally contributes to HIV eradication".
"The next Berlin Patient's experience suggests that we can broaden the donor pool for these kinds of cases, although stem cell transplantation is only used in people who have another illness, such as leukaemia. This is also promising for future HIV cure strategies based on gene therapy, because it suggests that we don't have to eliminate every single piece of CCR5 to achieve remission," Lewin said.
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