After receiving a stem cell transplant, a 53-year-old German man previously diagnosed with HIV has lived for four years without any detectable levels of the virus in his body, making him the fifth confirmed case of a person cured of HIV.
The man, known as the “Düsseldorf patient,” is at least the third person cleared of HIV after a risky surgery to completely replace his bone marrow with HIV-resistant donor stem cells, according to a case report published February 20 in Nature Medicine.
“In this case and others, cells that have a natural mutation that makes them resistant to HIV can achieve HIV remission and eventually a cure,” says Yvonne Bryson, MD, a professor and HIV specialist at the David Geffen School of Medicine at the University of California in Los Angeles. Dr. Bryson led a research study of a New York patient cured of HIV, but wasn’t involved in the Düsseldorf case.
ART Therapy Can Make HIV Undetectable, but It’s Not a Cure
For years, antiretroviral therapy (ART) has been given to people with HIV with the aim of lowering the virus to nearly undetectable levels, which prevents it from being transmitted to other people. While ART has largely transformed HIV from a terminal illness to a manageable chronic condition, the immune system can still store reservoirs of the virus that start replicating and spreading if ART treatment is discontinued.
The handful of confirmed cases of people being cured of HIV involved people who had no detectable levels of the virus in their bodies even after long periods of time without taking ART. In the latest case, the Düsseldorf patient halted ART in 2018 and has remained HIV-free since then.
Every Case of Complete HIV Remission Involved Stem Cell Transplants
In the first known case of an HIV cure, a man known as the “Berlin patient” lived with HIV in remission for 12 years before dying of cancer. This patient received a stem cell transplant for leukemia, and the donor cells he received happened to have a mutation that blocks a protein known as CCR5 from helping HIV invade healthy cells.
Scientists reported an apparent HIV cure in a second man, known as the “London patient,” in 2019. Three years later, scientists announced two more potential cases of an HIV cure, one in New York and one in California.
But it’s unlikely that stem cell transplants would be performed anytime soon for HIV patients without leukemia because of the risks of this procedure, said the lead author of the latest case report, Björn-Erik Jensen of Düsseldorf University Hospital in Germany, in a February 21 article in the journal Nature.
“This case is another proof of concept, but is not ready for scale-up and relevance to a broader population,” Bryson says. “This provides additional hope for an HIV cure in those who have long-term HIV and also cancer requiring a stem cell transplant as part of the treatment.”
Antiviral Treatments Can Prevent and Manage HIV
A widely available HIV cure involving stem cell transplants is likely a long way off. But there is still a lot people can do to prevent HIV or remain healthy if they’re living with the virus.
Worldwide, almost 38 million people are living with HIV, and roughly 3 in 4 of them receive ART, according to UNAIDS. ART can keep the virus at undetectable levels, which means that an HIV-positive person can’t transmit the virus to a sexual partner — a prevention approach summed up by the NIH as "Undetectable=Untransmittable (U=U)."
According to the UK-based AIDS charity NAM, the almost one million people worldwide at high risk for HIV — including injection drug users and men who have sex with men — are on a different antiviral treatment regimen known as preexposure prophylaxis (PrEP) to minimize their risk of contracting HIV, although many barriers still exist to accessing this treatment, especially for minorities. PrEP is 99 percent effective at preventing sexually transmitted HIV, and 74 percent effective at preventing HIV among people who inject drugs, according to the Centers for Disease Control and Prevention (CDC).