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A study co-authored by Javier Martínez-Picado reports the world's second case of remission of HIV without anti-retroviral drugs

Clotet, Martínez-Picado, Font and Salgado at the study's presentation

A study co-authored by Javier Martínez-Picado reports the world's second case of remission of HIV without anti-retroviral drugs

Last Tuesday, the journal Nature published the case of a person harbouring HIV who underwent a stem cell transplant to treat a lymphoma, and who has been in remission from the virus for 18 months, despite not receiving anti-retroviral treatment. This is the second case in the world after the "Berlin Patient" reported in 2009, as since then, every time the treatment had been withdrawn after a transplant, the virus has returned within a year. The study was led by University College London, and carried out by the international consortium IciStem, coordinated by the IrsiCaixa AIDS Research Institute (Barcelona) and the University Medical Center in Utrecht (the Netherlands). The team of researchers includes Javier Martínez-Picado, a lecturer at the UVic-UCC and a member of the Chair in AIDS and Related Diseases, who is also an ICREA researcher at IrsiCaixa and joint leader of the IciStem consortium.

The results of the publication were presented by Martínez-Picado this week, at a press conference which also featured Bonaventura Clotet, director of the AIDS Chair and IrsiCaixa; Àngel Font, Corporate Director of Research and Strategy at the "la Caixa" Bank Foundation, and Maria Salgado, researcher at IrsiCaixa and co-author of the study. On Tuesday, to mark the publication in Nature, they also presented the study at the Conference of Retrovirus and Opportunistic Infections (CROI) in Seattle.

18 months without anti-retroviral treatment

The patient had been HIV-positive since 2003, and was found to have Hodgkin's lymphoma in 2012. The patient underwent a stem cell transplant in 2016. The donor cells had a mutation, known as CCR5 Delta 32, which prevents the virus from entering the target cells for HIV, CD4 T lymphocytes. The doctors stopped the anti-retroviral treatment after 16 months, and today, 18 months later, the virus is still undetectable in the patient's blood. When people who are HIV-positive stop the treatment, the virus usually returns within 4 weeks.

The case published in Nature is therefore the world's second case of remission of HIV. "The main conclusion that we have drawn from all this information," says Javier Martínez-Picado, is that the 'Berlin Patient' was not merely an isolated case, and it is possible to achieve a complete remission of the virus." The researcher adds that "nevertheless, it's still too early to talk about a cure, but more than one year without the virus returning is something that hasn't been seen since the 'Berlin Patient', which is why we are very optimistic," he adds.

Differences and similarities with the "Berlin Patient"

The study in Nature emphasises differences with the "Berlin Patient". While the "Berlin Patient's" original cells already partially presented the CCR5 Delta 32 mutation, the new patient did not originally have it. Furthermore, the patient discussed in Nature underwent a much less aggressive pre-transplant therapy and received a single transplant, while the "Berlin Patient" underwent surgery twice. According to the researchers, this shows that remission can be achieved even without the recipient having a prior mutation, and with treatments that are much less aggressive for the patient.

However, there are also some common factors between the two patients. Both of them received a transplant with the CCR5 Delta 32 mutation, both presented a temporary graft syndrome against the host (a common situation after a transplant, in which the cells from the donor attack the cells of the recipient) and in both cases, the recipient's peripheral blood cells were completely replaced by those of the donor.

The target: the viral reservoir

Meanwhile, Bonaventura Clotet highlights the importance of a study that provides new data on how to eliminate the viral reservoir, the main cause of which HIV cannot be eradicated. "Proving that these hideouts for viruses are gradually being reduced will be crucial for confirming that we are applying the right strategies for the cure," he explains.

The researchers also stress that stem cell transplantation is a high risk medical procedure, and it is only recommended for treating patients who suffer from a haematological illness that cannot be treated using other therapies. They also emphasise that anti-retroviral treatment can only be withdrawn subject to a doctor's decision, and with thorough monitoring of the patient's evolution.

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