During the 24th International AIDS Conference (AIDS 2022), being held in Montreal, Canada, 2 new reported cases of long HIV remission continues fueling the optimism for reaching HIV cure. In 2007, Timothy Brown, demonstrated that, exceptionally, HIV can be cured. Timothy died due to leukemia in 2020, but other 4 cases followed the same path. This 5th case (1) presented at AIDS 2022 is a 66-year-old American man who was diagnosed leukemia in 2018 and that underwent a blood stem cell transplant from a delta 32 CCR5 donor (subjects with a rare mutation that makes the cell resistant to HIV infection). He stopped his antiretroviral treatment 17 months ago and since then, HIV could not be found in multiples samples, including biopsies of intestinal tissue and ultrasensitive viral techniques.
Although this case does not have immediate or direct clinical implications, as the procedure is complex, carries significant risk and is reserved only for those patients requiring the transplant due to the presence of a malignancy, it calls for continuing researching in the development of techniques that can simulate these resistant cells in HIV patients such as gene editing techniques.
The second case (2) is 59-year-old woman, who presented a severe acute HIV infection in 2006 and that initiated antiretroviral treatment, in addition to ciclosporin (an immunosuppressive drug used as an experimental co-therapy to reduce immune activation caused by HIV), in the context of a clinical trial at the Hospital Clinic of Barcelona. More than 15 years ago the investigators stopped her treatment, and the virus did not rebound since then. However, the virus could be detected. She is presented now as a case of HIV remission because the residual virus (known as reservoir) that could be detected since de moment she stopped treatment gradually decreased. Researchers could identify the mechanism associated with this reduction, specifically the presence of high levels of memory-like natural killer cells and gamma delta T cytotoxic cells that worked in tandem to block the infection of new cells and destroying the cells already infected. This is the first time this mechanism is reported, opening new routes to explore different interventions to stimulate these specific cells and reach long term HIV control and cure.
“These 2 cases show that we are in the right direction but we still have a long way to go before HIV long remission or cure becomes a reality for PLHIV,” said Dr Meg Doherty, Director of WHO Global HIV, Hepatitis and STI Programmes. “To achieve the goal of ending the AIDS epidemic by 2030, the global HIV response must continue to promote synergies under a universal health coverage and primary health care framework, with a precise focus to reach the people most affected and at risk.”
1. Dickter J et al. The ‘City of Hope’ Patient: prolonged HIV-1 remission without antiretrovirals (ART) after allogeneic hematopoietic stem cell transplantation (aHCT) of CCR5-delta 32/delta32 donor cells for acute myelogenous leukemia, (AML). AIDS 2022, 29 July – 2 August 2022. Oral late-breaker abstract OALBB0104.
https://www.aids2022.org/wp-content/uploads/2022/08/AIDS2022_abstract_book.pdf
2. Climent et al. Exceptional post-treatment control associated with strong NK and cytotoxic T cells. AIDS 2022, 29 July – 2 August 2022. Oral abstract OAA0205.
https://www.aids2022.org/wp-content/uploads/2022/08/AIDS2022_abstract_book.pdf