London patient still HIV-free 30 months after bone marrow transplant

The 11th SA AIDS conference, recently held in Durban, highlighted the worrying fact that key HIV numbers such as treatment coverage are much lower in children than in adults. PHOTO: TAC Archive

The so-called “London patient” is still HIV-free, 30 months after receiving a bone marrow transplant to treat blood cancer, according to a study published on Tuesday in the Lancet HIV journal.

While the study authors titled the study as “Evidence for HIV-1 cure”, Spotlight asked local HIV scientist Professor Francois Venter, from the Wits Reproductive Health and HIV Institute, if we can say with certainty that this patient has been cured.
“No,” he said. “It’s one of the dreadfully frustrating things about this approach, as it’s possible that the virus is hiding out somewhere and may come back. Having said that, it’s pretty much a cure if there is no virus around – no inflammation, no immune damage and no transmission.”

In the study, researchers used “ultrasensitive viral load” tests to look for HIV DNA in different parts of the patient’s body including in plasma, semen and cerebrospinal fluid. They found no trace of HIV 30 months after the individual underwent a stem cell, or bone marrow, transplant, despite the fact that he had not been on antiretroviral treatment (ART) for this period. When working well ART can lower the amount of virus in the body to undetectable levels.

Last year it was reported that this patient was HIV-free at 18 months of follow up.
On Monday, in an interview with the New York Times, the “London patient” revealed his identity to the public. Adam Castillejo said he has been living with HIV since 2003 and is the second such patient who has been effectively cleared of HIV.

‘Berlin Patient’
Timothy Brown, known as the “Berlin patient”, was the first to be effectively cured after undergoing similar treatment to Castillejo.
“This is a unique position to be in, a unique and very humbling position. I want to be an ambassador of hope,” said Castillejo to the New York Times.
Interest in a cure for HIV is growing in the scientific community, fuelled by these two cases.
“With the need for lifelong treatment of HIV with antiretroviral therapy (ART), and the associated costs, adverse events, and stigma, there is a growing need and a global scientific effort to find a cure, with many interventions being currently assessed in animal models and clinical trials,” noted infectious disease expert Professor Sharon Lewin in a commentary paper published alongside the study in the Lancet.

Not feasible for broad application
According to Venter, this specific treatment option is not feasible for broad application but it could help researchers find one that is.
“Unfortunately, transplants are very toxic and very expensive and complex, and would never be used in their current form for people without another serious illness. The cure was a happy side effect – and allows us to study this side of things,” he said. “However, it is vital research as it allows us to understand the immune system and how it reacts to the virus, as well as strategies to get to those hard-to-get-to places.”
“In view of the many cells sampled in this case, and the absence of any intact virus, is the London patient truly cured? The additional data provided in this follow-up case report is encouraging but, in the end, only time will tell,” said Lewin.