You might have heard about the story that broke last week — a second person “cured” of HIV.
Nicknamed the “London patient,” he underwent a cancer treatment which prevented the virus from re-infecting his donor cells, thus effectively clearing his immune system of all trace of HIV.
Newspaper front pages loudly proclaimed that he is cured and we’re now a great step closer to curing HIV infection.
Unfortunately, beyond the sensational headlines lies the truth that it’s too early to say he’s cured, and the treatment he received is not breakthrough medicine.
I attended the formal presentation of this case at the recent CROI conference in Seattle, Washington. The London patient had a very nasty blood cancer called Hodgkin’s Lymphoma, and he had failed all chemotherapy options, which is why he was offered a bone marrow transplant, similar to the “Berlin patient,” Timothy Ray Brown.
Brown had a different type of cancer — acute myeloid leukaemia — and he also had a bone marrow transplant after failing chemotherapy and total body irradiation.
The transplanted cells came from a donor with a genetic mutation which made his cells immune to HIV infection, and so the virus was no longer able to take up residence in his T cells.
This rendered him effectively free of HIV.
Brown has remained HIV-free for 9 years now with no further treatment, is not on any HIV drugs, and is considered cured.
Doctors have unsuccessfully attempted to replicate this cure with other HIV patients.
The London patient underwent a bone marrow transplant too, again from a donor who had a slightly different genetic mutation, but with the same result — the virus was no longer able to enter his T-cells, so disappeared.
The cancer was going to kill this man, so a bone marrow transplant was his last chance.
It was no walk in the park for him. Before someone has a bone marrow transplant their entire cellular immune system must be destroyed so that the donor cells won’t be rejected.
It’s a risky procedure, and people die from complications before they’ve even had the transplant.
Sometimes the transplant will be rejected by their body, making them very sick. The London patient became dangerously ill several times after his transplant and was in hospital for nearly five weeks.
It’s not new science, more a proof of concept — that HIV can be eradicated from the body by changing the cells which it usually infects so that the virus can no longer enter the cell.
Given the risks and expense of this procedure, and its unreliability, it is obviously not a treatment option that can be rolled out for the millions of people with HIV worldwide.
Long-term antiviral therapy to suppress the virus remains the standard of care for now and probably for the foreseeable future.