- Two more patients were declared functionally “cured” of HIV during AIDS 2022.
- An immunocompromised male patient underwent HIV bone marrow transplantation
- Another person, a woman, has an “abnormal” number of special cells that attack HIV, making her an “elite controller” of the infection.
Scientists announced at AIDS 2022 in Montreal this week that two more HIV patients have been “cured” of the human immunodeficiency virus.
One person has cancer, and the other is a woman with a mysterious and special innate ability, apparently a virus, after treatment.
The findings — both extremely rare — are two distinct glimmers of hope for HIV/AIDS researchers in the hunt for a cure for the disease achieved by two different mechanisms. Scientists prefer to say that these people are in “long-term remission” because we cannot say that the cures are permanent. However, both new cases had little (if any) evidence of HIV replication in their bodies for several years, a good indication that this was not a temporary fix.
Several other cases like these two patients have been reported around the world in recent years, and the pace of these two different brands of “cures” is accelerating.
“Cure” #1: A special type of cancer treatment
The first patient to be considered functionally cured of HIV was an anonymous man known as the “City of Hope” patient (the name of the cancer center in California where he was treated for leukemia).
The City of Hope patient’s “cure” is the result of a one-two punch against cancer and HIV: a bone marrow transplant with AIDS-resistant cells. Currently, the 66-year-old patient was 31 years old, and at the age of 63, he underwent HIV transplantation for leukemia.
His doctor, Jana Dikter, said during a presentation Monday at the AIDS 2022 conference in Montreal that there was “no evidence of HIV replication” in his body.
“The goal of this transplant was to cure his leukemia,” he said, but the same strategy could work for others diagnosed with leukemia and HIV in the future.
There are at least two other men who have been effectively “cured” of HIV through similar bone marrow transplants – a Berlin patient (in 2007) and a London patient (published in 2019). In February, a New York woman became the first female leukemia patient to be cured of HIV and a blood cancer, thanks to a new umbilical cord blood transplant.
In all of these publicized cases, patients were treated for cancer by transplanting HIV-resistant blood cells from donors with specific mutations that destroy the virus. There is another man from Dusseldorf, Germany, who appears to have been cured in this way, but his doctors were careful not to publish his case in the medical literature.
While the City of Hope treatment may not be a widespread cure for all people living with HIV around the world, “we are now seeing more blood cancers” in older HIV-positive patients in the U.S., Dicker said. and this strategy can help some of them.
“Cure” #2: “Elite” disease management, of course
The other HIV “cure” announced at AIDS 2022 came after a woman in Spain who had been HIV-free for 15 years completed treatment with generic antiretroviral drugs. (Typically, when patients stop taking their HIV medications, they relapse.)
He is believed to be part of an unusual group of people around the world known as “elite controllers,” whose bodies naturally attack HIV, suppress it, and in some cases even eradicate it without medication.
Dr. Núria Climent Vidal from Barcelona said the anonymous patient’s total HIV-1 DNA was reduced by 98%.
“Maybe he has special genetic factors,” Vidal said at a conference on Sunday, adding that the patient had an “atypical” number of special natural killer cells that can attack HIV.
Although it is unclear exactly how many of these elite controllers exist worldwide, at least two additional cases of what are believed to be natural HIV controls have emerged in recent years.
Laurin Willenberg of California, another “elite controller” who contracted HIV in 1992, had no traces of the virus in his body. This was the natural control of another woman diagnosed with HIV in Argentina in 2013. Her daughter, born in 2020, is HIV-free, which is usually achieved only through antiretroviral therapy (ART) during pregnancy.
The findings of the “elite controller” – achieved with or without drugs – are more interesting for the tens of millions of people living with HIV worldwide who do not have blood cancer. Although the mechanism of elite control is somewhat mysterious, “it may not translate to other people,” says Dr. Bruce Walker, an HIV researcher at the Ragon Institute in Massachusetts, said in 2020.