Researchers Document Second Case of Sustained HIV Remission

An individual treated for HIV is believed to be in long-term remission, according to experts in the United Kingdom. 'The London Patient' is only the second documented case of sustained remission for HIV infection.¹

In Seattle, WA, Ravindra K. Gupta, University College London, presented the case Tuesday at the Conference on Retroviruses and Opportunistic Infections (CROI 2019). He compared the London Patient with the first known case of long-term remission, an outcome researchers have been attempting to duplicate for years.¹

Timothy Ray Brown, formerly known as the Berlin Patient, has been living more than 10 years in long-term remission without antiretroviral therapy (ART), following treament for acute myelogenous leukemia, as well as HIV. His case was made public at CROI 2008. However, Gupta said although the case drove the research for the development of a cure, it also left questions unanswered.¹

“What was responsible for the long term remission? Was it the chemotherapy regiment, specifically? Was it the fact that there were 2 rounds of treatment required in this individual, each time with stem cell transplant? What was the role of total body irradiation? And also, graft vs host disease? And increasingly, there was some speculation that was there some unmeasured patient factor that played a role in long-term remission,” said Gupta.¹

The London Patient, who has not been identified, was diagnosed with HIV in 2003, according to Gupta. He was not started on ART until 2013, at which point the London Patient was diagnosed with Stage IVb Hodgkin lymphoma.¹

In both cases, sustained HIV remission was achieved following bone marrow transplantation for the treatment of cancer. Gupta said there were several other similarities noted between Brown and the London Patient.¹

“Both had R5 using viruses,” said Gupta.¹ “Both patients had mild GVH, and both patients had 100% T cell donor chimerism.”

Differences between the 2 patients also were noted in Gupta’s presentation.¹

“Our individual’s homozygous for wild type CCR5 in contrast to Timothy Brown's heterozygous for Delta 32,” said Gupta. “The underlying cancer was different. Our individual only had 1 transplantation procedure, without irradiation, and with reduced intensity conditioning.”

The T cell depletion was also different, Gupta noted.¹

Still, the London Patient has HIV experts hopeful that long-term remission may be duplicated again.^1-2

In an interview with Contagion, Paul Sax, MD, clinical director of Infectious Diseases at Brigham and Women’s Hospital, said that while the London Patient’s case does not represent a path to long-term remission for the millions of people with HIV, it does show that Brown was not a “one off” and there potential ways for achieving the same outcome with other individuals.²

“There were a lot of similarities between this case and the person who has been cured previously. There's a lot of reason for optimism,” said Sax.²

References

• Gupta R. Sustained HIV-1 Remission Following Homozygous CCR5 Delta32 Allogenic HSCT. Presented at: Conference on Retroviruses and Opportunistic Infections (CROI 2019), Seattle, WA. March 5, 2019.
• Paul Sax, MD, Reacts to News of the London Patient. Contagion Live. https://www.contagionlive.com/videos/paul-sax-md-reacts-to-news-of-the-london-patient. Published March 11, 2019. Accessed March 16, 2019.