London Patient
12 years after the "Berlin Patient", a second, "London patient" joins him
Ivan Shunin, "The Attic"
It is believed that in history there was only one person whom doctors were able to cure of the human immunodeficiency virus – this is Timothy Ray Brown, or the "Berlin patient". In 2007, he underwent a bone marrow hematopoietic stem cell transplant, and a few years later, doctors no longer found HIV in Brown's blood. Now there are two such people: as it became known to journalists from Science, an international group of doctors managed to achieve the same effect in exactly the same way by transplanting bone marrow stem hematopoietic cells from a donor with a mutant CCR5 gene to a patient. An article about the operation will be published in the journal Nature, and its lead author will make a presentation at a conference in Seattle today.
The human immunodeficiency virus affects the cells of the immune system, the work of the immune system is suppressed, and at some point a person develops acquired human immunodeficiency syndrome (AIDS). The body of an AIDS patient cannot protect itself from infections and risks an early death without proper medical support. In 2017, the number of official HIV victims/AIDS, according to WHO, numbered more than 35 million; in 2017 alone, about a million people died from it.
In 2007, Berlin doctors performed an operation to transplant hematopoietic stem cells (aka transplantation of hematopoietic stem cells of bone marrow, aka bone marrow transplantation) from a donor whose genome had the CCR5Δ32 mutation to a person named Timothy Ray Brown, who had both leukemia and HIV. A year later, leukemia returned, and the operation was performed again. In 2009, traces of the virus could no longer be found in Brown's blood. Brown's case was the only one in medical practice, and the community was not completely sure that his healing was the result of only an operation, extremely expensive and complex.
Now, the skepticism of those who previously had reason to doubt the effectiveness of such a method of HIV treatment should decrease. The second example of successful healing from HIV with the help of bone marrow transplantation serves as a weighty argument in favor of recognizing this method as effective. Although it is still too expensive and complicated to talk about the coming victory of humanity over HIV: most of the virus disease, two-thirds of the global number, today falls on African countries.
The article published in the journal Nature is written by researchers from the UK, Spain, the Netherlands and Singapore. The lead author of the study is Ravindra Gupta, a British physician of Indian origin.
As he writes Science, Gupta himself avoids using the term "healing" in relation to his patient, preferring to talk about "long–term remission" - in particular, because scientists have not yet analyzed any other tissues of the "London patient", in addition to blood.
Science also recalls that other patients with HIV have tried to transplant the bone marrow of donors, but until today, doctors – apart from Brown's case – have not been able to achieve complete purification of their blood from HIV. Gupta admitted to reporters that he himself was not sure of success.
The London patient, unlike the Berlin one, did not undergo such intensive treatment: Brown not only went through two transplants, but also received a long course of chemotherapy and radiotherapy. Gupta's patient, who also suffered from two diseases at once – Hodgkin's lymphoma and HIV, received only treatment that was aimed at fighting lymphoma.
Gupta's operation is part of a project conducted by the amfAR Foundation and has been going on since 2014. The London patient is one of 40 participants in this study.
The interlocutors of Science agree that the current case highlights the role of the mutant CCR5 gene obtained from a donor in the success of such a method of HIV treatment. As Stephen Dix from the University of California says in a conversation with Science, these results will spur attempts to treat HIV by "breaking" CCR5, without resorting to "heroic interventions, as was done with the Berlin and London patients." He also mentions the attempts of his colleagues to replace white blood cells in HIV-infected patients with genetically modified ones using zinc fingers (a genome editing tool of the previous, "pre-hispanic" generation). In these cases, HIV could not be defeated, but the virus returned to the cells of patients who underwent similar gene therapy much more slowly.
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