Romuald, the first person to be cured of HIV after a bone marrow transplant, opened new ways to cure the disease.

2024-09-03 14:21:44

The so-called “Geneva patient” has been declared free of HIV after receiving a stem cell transplant, becoming the first person to achieve viral remission without the need for the CCR5-delta 32 mutation, known to confer resistance to HIV . Preliminary data from this issue were presented in 2023 and have now been published in the journal ‘Nature’s medicine‘. Three years after stopping his antiretroviral treatment, the virus was undetectable in Romuald’s blood.

Diagnosed with HIV in 1990, Romuald start antiretroviral treatment immediately. In 2018, after being diagnosed with myeloid sarcoma, he received a stem cell transplant from a non-regenerative matching donor. CCR5-delta 32. This rare genetic mutation, which is most important in central and northern Europe, causes the absence of a docking site for HIV on immune cells, providing good protection against infection with the virus. So far, the cases of people recovering have received a transfer from the donor who has this change.

“This case is particularly important because it shows that HIV recovery is possible even without the CCR532 mutation,” explained Javier Martínez-Picado, coordinator of the committee. I’m here and the researcher IrsiCaixa.

Romuald is therefore a case in point impossible. After the transplant, the medical team observed a significant reduction in HIV-infected cells and no sign of viral replication, something unusual in transplant patients without the CCR532 mutation. “We found that there was no virus in the blood or signs of active HIV and we decided to stop the treatment and see what happens.”

Five other people who have been cured of HIV so far have received a stem cell transplant from a transplant-matched donor. Researchers think that this change is the key to curing these cases, but many groups, such as the IciStem consortium, question whether it is necessary.

The study is now published’Nature’s medicine‘ answer this question.

Furthermore, research has identified possible mechanisms that may be behind this remission, opening new avenues of research into HIV eradication.

Alloimmunity

Martínez Picado points to two factors: alloimmunity, the interaction between the immune systems of the donor and the recipient, and the use of the immunosuppressant ruxolitinib. “Allogeneic vaccine of patient produced donor cells”colony‘and remove those who are taken from the recipient, including those who are HIV positive,” he explained to ABC Salud.

But another part, the call takes place after transfer graft versus host diseaseis a common life-threatening complication in bone marrow transplantation involving immunosuppressive drugs. In this case, we used ruxolitinib, an immunosuppressant known to work on the way HIV needs to be reactivated, explained the researcher.

egg killer

Likewise, it shows, in the case of Romuald something different was observed related to the type of cells of the immune system, called. Natural killer (NK). “They are cells that specialize in destroying stress signaling cells and in this patient they are more active and functional than usual.”

This case is the first of two recent cases showing that HIV remission can be achieved without changing protection.

Of those International AIDS Conferencein Munich, another similar case was presented, where the donor had only one copy of the CCR532 mutation, leading to the possibility of new treatment methods.

Although stem cell transplantation is not a widespread option for people with HIV, the success of the ‘Geneva patient’ opens new perspectives for research. In this sense, Martínez Picado told ABC Salud, “we research new ways to achieve this complete colonization without the need for transplantation. “This will make this option scalable for more patients and not just for cases in which HIV infection coincides with blood cancer.”

Martínez Picado is sure that “he will succeed” and also emphasizes that everything that is improved in this field “will be useful for possible new viruses that may appear in the future.”

The study is the result of the work of the IciStem Consortium, led by the Geneva University Hospitalhim Pasteur Instituteand IrsiCaixa, in collaboration with the University of Utrecht.