December 17th, 2010

Update on Berlin Patient II: Still Cured of HIV

First, who was Berlin Patient I?

Second, over in the journal Blood is the latest update on Berlin Patient II, the guy apparently cured of HIV by bone marrow transplantation:

We have previously reported the case of an HIV-infected patient in whom viral replication remained absent despite discontinuation of antiretroviral therapy after transplantation with CCR5Δ32/Δ32 stem cells…  In the present study, we demonstrate successful reconstitution of CD4+ T cells at the systemic level as well as in the gut mucosal immune system following CCR5Δ32/Δ32 stem cell transplantation, while the patient remains without any sign of HIV infection… In conclusion, our results strongly suggest that cure of HIV has been achieved in this patient.

Ever since this was first presented as a poster at CROI in 2008, it was pretty clear that this was a special case, and I’ve written about it several times before — first time here.

What’s different now, of course, is that the longer duration of follow-up has allowed the authors to give much more detailed information about both his virologic and immunologic status — and to make more confident statements that he is in fact cured of HIV.

berlinAnd I agree.

But numerous questions about this fascinating case remain, including the biggie — how did this happen? Was it the CCR5-negative status of the donor’s cells?  Something about the “conditioning” (there’s a euphemism for you) regimen?  The fact that he’d been virologically suppressed when he went into the transplant?  (It’s obviously not just this.)  Some combination of the above?

And though of course this transplant strategy can’t be widely adopted, one would expect at least one other similar case to surface soon, right?

By the way, for HIV history trivia buffs, this guy was Berlin Patient I.  Must be something in the water.

2 Responses to “Update on Berlin Patient II: Still Cured of HIV”

  1. ahmad hosseinipour MD says:

    I have several questions:
    1. Was the patient truly infected with HIV?
    2. Was this patient cured with chemtherapy alone?
    3, Was the patient cured by the bone marrow transplant?
    Thank you

    • Paul Sax says:

      Ahmad, in response:

      1. Yes, documented several times, including reactive HIV serology and detectable HIV RNA when he stopped medications early in transplant.
      2. Doubtful, as many people with HIV have received chemotherapy, and they are not cured.
      3. Probably the transplant has something to do with it.

      Bottom line: we don’t know if it was predominantly the “conditioning” pre-transplant or the distinctive aspects of the transplant itself that led to the cure.

      Regardless, it’s a fascinating case, and a real incentive to keep looking for a strategy for eradication that is safer and more practical!

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.