CROI 2019

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Press release CROI 2019

A step closer to an HIV cure. No rebound of HIV in two patients who stopped taking their HIV medication after stem cell transplantation for a hematological disease

Medical experts have found no evidence of an infectious virus for months in two HIV patients who stopped their antiviral medication. Both patients underwent stem cell transplantation as part of their cancer treatment. The transplanted donor cells had a gene defect (CCR5delta32mutant), which results in the absence of one of the critical entry gatekeepers that HIV generally needs to infect cells. One of the patients has been without antiretroviral treatment for 18 months, so experts are especially optimistic regarding a possible cure. The other case of HIV was undetectable after 3,5 months without antiviral medication.

Thus far, only one person in the world, ‘the Berlin patient’, has been cured of HIV. Although traces of HIV were found, HIV never rebounded and he is now celebrating his 12th anniversary of being cured. The transplanted cells from a CCR5delta32 donor most likely protected his immune system. He also received aggressive chemotherapy, total body irradiation and two stem cell transplants. For over a decade, the HIV field has been puzzled regarding which of these factors were essential for his cure.

Today, Professor Ravi Gupta of the University College London and the University of Cambridge, presented the breaking news of a new case with a possible HIV cure at the international Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle and will be published in Nature today. His London patient has not experienced HIV rebound during the 18 months after he stopped taking his antiviral medication. This is the longest adult HIV remission after stem cell transplantation since the Berlin patient. Usually, when HIV+ individuals stop treatment, the virus rebounds within the first month.

A second potential cure from HIV after stem cell transplantation will be presented by Dr. Björn Jensen from Düsseldorf University. This patient stopped using his HIV medication for a shorter period of 3,5 months and has also remained HIV free. In previous cases of antiretroviral interruption after a stem cell transplant without the CCR5 Delta 32 mutation, the virus rebounded at month 3, 8 and 10, respectively.

The patients were investigated by internationally renowned researchers. Both patients are registered to the IciStem program. IciStem is a joint venture of collaborating researchers and clinicians who share their expertise on HIV cure and stem cell transplantation to gain insight into the mechanisms of HIV eradication.

In both patients only traces of HIV DNA were detected with the most sensitive techniques available to date, similar to the case of ‘the Berlin patient’. According to the principal investigators of IciStem, P. Annemarie Wensing, from the University Medical Center of Utrecht (The Netherlands), and Javier Martinez-Picado, from the IrsiCaixa AIDS Research Institute (Barcelona, Spain), these cases support the further investigation of CCR5 related gene therapy.

The cases show that, even with one transplant, mild cancer chemotherapy and without radiation, remission may be achieved.

Today, 39 patients who are registered with the IciStem program have received a transplant. IciStem has the largest program to investigate HIV cure following stem cell transplantation, and has identified more than 22,000 donors with the rare CCR5delta32 gene defect. IciStem investigator Gero Hütter, who was the physician who performed the transplant on the ‘Berlin patient’. was instrumental in this aspect of the program . IciStem is funded by the Foundation for AIDS Research (amfAR).

Information for patients

IciStem investigates systematically the HIV reservoir in people living with HIV who either had or may get an allogeneic stem cell transplantation. Each patient registered at the IciStem program participates in a local study led by his/her treating physicians. IciStem advises systematic collection of clinical data and blood, tissue and CSF samples before and after the stem cell transplantation. The IciStem consortium contains a network of highly specialized expert laboratories that can perform the most sensitive tests available to date to measure the HIV reservoir and the quality of the immune system.

Despite all the sensitive tests available to date, the only way to evaluate whether the HIV reservoir has been controlled or cleared is to interrupt antiretroviral therapy (ART). However, ART interruption must only be performed by patients who have been informed about the risk of therapy interruption and have signed an informed consent. Furthermore, interruption of ART should be performed in a controlled clinical setting with monitoring over time of a possible viral rebound and the ability for scientifically evaluation.

IciStem is very grateful for all participating patients for assisting in the search for a cure. We understand that the news about patients who discontinued therapy and did not experience a viral a rebound thus far is hope giving. We want to emphasize this has been done after thoroughly testing of the HIV reservoir and with strict monitoring

People living with HIV who have received or will receive an allogeneic transplantation and who are interested to be registered to IciStem, may ask their treating physician to contact the IciStem team.

We can imagine that the HIV positive patients who do not have a hematological disease requiring a stem cell transplantation visiting our website, would like to participate. Unfortunately, stem cell transplantation is an high risk procedure which comes with a high mortality and patients who do not have a hematological disease requiring a transplantation can therefore not be registered. We do hope we can provide knowledge in the nearby future which can translate the results of IciStem to a broader group of people living with HIV.

The IciStem project is currently supported by the Aidsfonds. IciStem was established with funding from the AmfAR Research Consortium on HIV eradication (ARCHE) Research Grant # 109858-64-RSRL