After the “patient from Berlin” in 2009 and the “patient from London” in 2019, a third person with HIV has been cured: the “patient from Düsseldorf” has had no trace of the virus in his body for four years. This cure, which was announced on Monday by the hospital in Düsseldorf (Germany), was made possible by the international consortium of scientific research institutes IciStem, of which the Institut Pasteur is a member.
Two other cases of healing also reportedly took place last year, but have not yet given rise to formal publications. Asier Sáez-Cirión, head of the Viral Reservoirs and Immune Control Unit at the Institut Pasteur and co-author of the study confirming the patient’s recovery, explains to 20 minutes how this man overcame HIV.
Who is the “Dusseldorf patient”?
Diagnosed in 2008 with HIV and on antiretroviral treatment, the man developed leukemia in 2011. After chemotherapy treatment, a relapse prompted his doctors at the German hospital to perform a bone marrow transplant. However, here, the donor carries a rare genetic mutation – 1% of the world’s population has it – which prevents HIV from entering cells, called CCR5Δ32.
“During a bone marrow transplant, the patient’s immune cells, which develop abnormally in the case of leukemia, are eliminated and replaced by those of a donor. Here, their disappearance also means a suppression of HIV-carrying cells,” explains Asier Sáez-Cirión. Thus, four years after stopping antiretroviral treatment, the researchers found no viral particles, no activatable viral reservoir, no immune responses against the virus in the patient’s body. The patient is therefore “probably cured”, with no risk of being HIV positive again, unlike remission, where the HIV positive person can stop treatment and be negative for the anti-HIV antibody test, but may still have a risk of seeing his virus reactivate.
What future for this treatment?
Unfortunately, “this strategy cannot be extrapolated”. So far, all the patients cured have blood cancer in common, which allowed them to benefit from a stem cell transplant, renewing their immune system in depth. “Marrow transplantation is a risky intervention, which is given to people with specific pathologies, such as leukemia, and who have no other therapeutic options”, explains Asier Sáez-Cirión. Indeed, many complications, such as aplasia, can occur following the operation, which requires a long hospital stay. In addition, according to the scientist, the post-transplant mortality rate remains high. For these reasons, this medical protocol is not possible for HIV-positive people on antiretroviral treatment without comorbidity.
Add to that the rules of donor-recipient compatibility and the low frequency of the Δ32 mutation, “we cannot offer this to the 38 million HIV-positive people in the world”, slips the researcher.
What lessons can be learned from this discovery?
“To be honest, when we had this announcement of a third healing, we were like, ‘what’s up?’” 20 minutes the general manager of Sidaction Florence Thune. “We are measured vis-à-vis this discovery,” she explains. De factothe conditions for the treatment of the “Dusseldorf patient” are so precise that they do not allow us to imagine a generalization of this risky protocol to the 173,000 French men and women carrying HIV.
However, “the results obtained during the study provide leads for developing therapies”, notes the scientist. “In particular, to develop a treatment to allow more remissions”, adds the director of Sidaction. If the goal of a treatment to cure HIV remains a long-term objective, it seems remote because this virus is so complex. “Today, thanks to an injection, HIV-positive people can put the virus under a bell jar for two months, explains Florence Thune, the objective is to allow long-term remission thanks to a single dose of treatment. »