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CROI 2019: Will the "Düsseldorf patient" make three -- further propelling cure research?

Antigone Barton
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 Science Speaks is in Seattle this week covering breaking news in HIV research, policies and plans at CROI 2019 March 4-7.

Five years after a stem cell transplant with the same critical factor as those received by the Berlin patient and the London patient, and four months after stopping antiretroviral treatment, a Düsseldorf man remains virally suppressed

SEATTLE - Exemplifying both the caution and the optimism essential to HIV cure science, Dr. Björn-Erik Ole Jensen won't say his patient's virus is "in remission" -- yet. He will only note that four months after discontinuing antiretroviral treatment, his patient shows no sign of active HIV. Like the London patient, reported this week, and like Timothy Ray Brown, both of whom received stem cell transplants from donors with a gene mutation resistant against a form of HIV, the patient in Düsseldorf received a similar transplant, in his case, five years ago. Mr. Brown has gone more than a decade without HIV medicine, and is considered cured. The London patient has gone 18 months, and his physician, who presented his case on Tuesday, prefers, at this point, the term "in remission." At four months since the patient in Düsseldorf stopped taking his antiretroviral medicine regimen, Dr. Ole Jensen prefers the term "treatment interruption," while listing the types tissue samples analyzed extensively that showed no signs of replicable virus both before and since the patient made the informed decision to go off his regimen in November 2018. "We can at least say the viral reservoir is extremely low," Dr. Ole Jensen said in front of a poster describing the case Wednesday. "Signals" have been noted, he said, "that are difficult to interpret." Those signals don't indicate, however, "functional virus." "We are pretty optimistic," he acknowledged. So why not say the patient is in remission? "It's early." Normally a person living with HIV who stops treatment will see the virus rebound within weeks, he noted. But other cases, including those of two patients in Boston who discontinued treatment after stem cell transplants, viral rebound took longer -- but did eventually occur, Dr. Ole added. Dr. Daniel Kuritzkes, who treated the Boston patients, was perusing posters in the next aisle, and didn't have to pause to think, when asked: One patient's viral levels rebounded in 12 weeks, the other's in 200 days. Setting a time when a patient can be considered either "cured," or "in remission," is really challenging, Dr. Kuritzkes agreed. "There's no consensus." Still, consensus on the common factors of the latest two patients continues to focus on the promise of the CCR5 mutation -- to a cell receptor that lets HIV in. Neither of the Boston patients received a transplant with the CCR5 mutation that resists HIV. While offering a promising path for research, it is a mutation that is predominately found in northern Europe. The bone marrow donor registry in Düsseldorf tested about two million samples for the mutation and found more than 20,000. In Spain, Portugal and Italy the mutation is harder to find, Dr. Ole Jensen said. In Africa, home to more people living with HIV than any other geographic area, it is just about unheard of. In the meantime, the Düsseldorf  patient is doing well, five years post-transplant, four months post-"treatment interruption." He dropped into the clinic in Düsseldorf today, Dr. Ole Jensen said, where he continues to be checked twice weekly. "Longer surveillance is essential," The poster on his case concludes.


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