CROI 2019—Second patient achieves HIV cure after stem-cell therapy


  • Jim Kling
  • Conference Reports
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Takeaway

  • A London man infected with HIV who received a CCR5 delta32 allogeneic hematopoietic stem cell transplant (HSCT) to treat Hodgkin's lymphoma has been free of the virus for 17 months after stopping antiretroviral therapy (ART).

Why this matters

  • After the "Berlin" patient had a similar outcome over a decade ago, the results suggest that CCR5 modification could be a route to a cure.
  • Unlike the "Berlin" patient, the "London" man did not undergo whole-body radiation.

Study design

  • Case study.
  • Funding: None disclosed.

Key results

  • The first known cure, the "Berlin" patient, was treated with 2 HSCTs and total body radiation.
  • The new patient, known as the "London" patient, begin ART in 2012 and had a nadir CD4 count of 290 cells/mm and a baseline viral load of 180,000 copies/mL.
  • The "London" patient failed first-line chemotherapy and multiple salvage attempts, and thus became a candidate for HSCT. Clinicians found an unrelated CCR5d32 homozygous donor who had 1 allelic mismatch at HLA-B.
  • The patient underwent conditioning with lomustine, cyclophosphamide, Ara-C, and etoposide; T-cell depletion using anti-CD52; and graft-versus-host disease (GvHD) prophylaxis with cyclosporine and methotrexate.
  • The patient experienced only mild GvHD.
  • HIV viral load remained undetectable for 17 months after interruption of ART.

Limitations

  • Single patient.