12 years ago the first H.I.V. patient was cured. Scientists have never succeeded in duplicating the procedure, until now. A patient in London has been cured after a bone marrow transplant.
H.I.V is one of the deadliest diseases known to mankind. Scientists aren't able to find a proper cure for the virus. But there has been only one person in history who has successfully beaten it. Scientists have been trying to duplicate the procedure ever since and have finally succeeded for the second time. The second victory over the virus comes 12 years after the first patient was cured. Scientists now claim that the procedure to cure the victim is difficult but not impossible. The reports of the procedure are said to be released by investigators sometime this week in the journal, Nature. Further details will also be discussed at the Conference on Retroviruses and Opportunistic Infections in Seattle. Publicly, scientists are calling this case a long-term remission. As reported by the New York Times, most experts believe that they have found the cure, with the caveat that it is hard to know how to define the word when there are only two known instances.
In both cases, the infection was cured after a bone-marrow transplant. However, both patients were also victims of cancer and the transplants were intended towards beating cancer and not the virus. Bone-marrow transplantation is unlikely to be a realistic treatment option in the near future. Now, there are powerful drugs available that help controls the infection. The transplants are said to be very risky and may have very harsh side effects. Experts say that rearming the body with immune cells similarly modified to resist H.I.V. positive virus might even succeed as the practical treatment to be used.
“This will inspire people that cure is not a dream,” said Dr. Annemarie Wensing, a virologist at the University Medical Center Utrecht in the Netherlands. “It’s reachable.” Dr. Wensing is co-leader of IciStem, a consortium of European scientists studying stem cell transplants to treat H.I.V. infection. The consortium is supported by AMFAR, the American AIDS research organization.
The new patient has chosen to remain anonymous. The scientists refer to him as 'the London patient'. “I feel a sense of responsibility to help the doctors understand how it happened so they can develop the science,” he told The New York Times in an email.
Breaking News: An HIV patient is said to have been cured for just the second time. The success may guide scientists to a new strategy for ending AIDS. https://t.co/DUmaTNxAgM— The New York Times (@nytimes) March 5, 2019
The patient mentioned that the feeling of knowing that he could be cured of both cancer and AIDS was "surreal" and "overwhelming". “I never thought that there would be a cure during my lifetime.” After the first case where the "Berlin patient" Timothy Ray Brown, 52, was cured, the scientists tried to duplicate his results with every other patient that was suffering from both cancer and H.IV. AIDS. In every case where they tried to duplicate the procedure, the virus always found it's way back within months. This was seen usually after the patients stopped taking antiretroviral drugs. In other cases, the patients died of cancer.
The case is a proof of the concept that scientists one day will be able to end AIDS.— Anirudh Chatterjee (@Anirudh1969) March 5, 2019
Mr. Brown was a victim of leukemia and needed two bone-marrow transplants since chemotherapy failed to work. The transplants that saved him were from a donor with a mutation in a protein called CCR5 which is found on the surface of some immune cells. H.I.V. uses the protein to enter those cells but cannot latch on to the mutated version. During the procedure, Mr. Brown was also given immunosuppressive drugs that are no longer available. He suffered intense complications for months. At one point, he was even placed in an induced coma and nearly lost his life. “He was really beaten up by the whole procedure,” said Dr. Steven Deeks, an AIDS expert at the University of California, San Francisco, who has treated Mr. Brown. “And so we’ve always wondered whether all that conditioning, a massive amount of destruction to his immune system, explained why Timothy was cured but no one else.”
Coming back to the London patient. According to the survivor, a near-death experience is not required for the procedure to work. The patient suffered from Hodgkin’s lymphoma and received a bone-marrow transplant from a donor with the CCR5 mutation in May 2016. He was also given immunosuppressive drugs, however, the treatment was not as intense. The patient quit taking anti-H.I.V. drugs in September 2017 and has remained virus free for over a year now. “I think this does change the game a little bit,” said Dr. Ravindra Gupta, a virologist at University College London who presented the findings at the Seattle meeting. “Everybody believed after the Berlin patient that you needed to nearly die basically to cure H.I.V., but now maybe you don’t.”
In the case of the London patient, the transplant killed the cancer cells without any harmful side effects. The transplanted immune cells, now resistant to H.I.V., seem to have fully replaced his vulnerable cells. Most people with the H.I.V.-resistant mutation, called delta 32, are of Northern European descent. So far, scientists have tried the procedure on 38 patients. They still await results on most of these patients. One of the victims known as the 'Düsseldorf patient' has been off anti-H.I.V. drugs for the past four months. There has been no sign of the virus coming back as of yet. Scientist are hoping that this turns out to be the third person to be cured by the procedure.
And if we do find a cure for cancer and AIDS, it'll be too expensive for anyone to actually get it except the wealthiest. Because heaven forbid we ever think of something besides money.— Lizard Person (@Baconpwn) March 5, 2019
The London patient has not yet shown any signs of the virus coming back. Similarities to the case of Mr. Brown only help scientists believe that he might live a healthy life from now on. Most experts who know the details agree that the new case seems like a legitimate cure, but some are uncertain of its relevance for AIDS treatment overall. “I’m not sure what this tells us,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “It was done with Timothy Ray Brown, and now here’s another case — ok, so now what? Now, where do we go with it?”
One possibility, said Dr. Deeks, is to develop gene therapy approaches to knock out CCR5 on immune cells or their predecessor stem cells. These cells will not just be resistant to the virus but might remove it from the body completely. Several companies are working towards gene therapies but have not yet been successful. The modification needs to target the right number of cells, in the right place, an tweak the genes directing the production of the CCR5.
“These are dreams, right? Things on the drawing table,” Dr. McCune said. “These dreams are motivated by cases like this — it helps us to imagine what might be done in the future.”
Mr. Brown says he is hopeful that the London patient’s cure proves as durable as his own. “If something has happened once in medical science, it can happen again,” Mr. Brown said. “I’ve been waiting for company for a long time.”