HTB

The London Patient tells his story as second person cured of HIV

Simon Collins, HIV i-Base

Early this morning, on Monday 9 March 2020, the second person to be cured of HIV allowed his story to be included in an interview in the New York Times. [1]

The article is available online (after free registration) and is focused on some of the personal responses from undergoing such difficult and rare treatments. It is also published ahead of a medical update on this case to be presented (virtually) at CROI 2020 tomorrow. [2]

This decision to go public requires a lot of courage – and it is clear from the interview that Adam – who still wants to be known as the London Patient – has been thinking about this for a long time. It is also clear that he is driven by the positive impact that his story can have for people who are undergoing cancer treatment as much as those of us who are HIV positive. It is also the outcome from approximately eight years of fighting cancer, after which, many people might happily retire with their health to lead a private life.

The article is mainly focused on the diagnosis in 2011 with stage 4 lymphoma and how this failed to respond to successive treatments over the next four years. Then, in 2015, after being told that there were no other treatment options, it was Adam, with help from a friend, who contacted the Chelsea and Westminster Hospital after learning online about their experience for treating HIV positive people with cancer.

The haematopoietic stem cell transplantation (HSCT) that then followed was complicated and difficult. This involves first having conditioning treatment to wipe his own natural immune system making someone very vulnerable to many serious infections. The stem cells are a type of bone cell transplant, but from a donor that has an immune system that is resistant to the most common type of HIV. After the transplant the body has to survive a battle against the new cells. This is called graft vs host (GvH) disease and often needs hospitalisation because the symptoms are so difficult.

Two years after the transplant, with full consent and under supervision of his medical team, Adam was able to stop his HIV medication, in order to see whether or not his HIV drugs were still needed.

An important caution, as the article explains, is that HSCT is not a cure for most people living with HIV. For all the news that the case will rightly generate, the ability to repeat this scientific breakthrough might be an outcome for only a few people. This procedure is a secondary outcome for advanced cancer that hasn’t responded to multiple treatments with chemotherapy.

Last year, tentative details of the London Patient were presented at CROI (and later published in Nature), with a conclusion that longer follow-up was needed for the remission to be classified as a cure. [3, 4, 5] A third case with less follow-up time off-ART – referred to as the Dusseldorf Patient – was also reported at the same conference. [6]

Although this is now the second case of an HIV cure using HSCT, the first case was reported in 2008 (initially as the Berlin Patient and later as Timothy Ray Brown). [7, 8, 9]

Since then, none of previous attempts to repeat the HSCT in other patients were successful. The important medical differences reported last year for the London and Dusseldorf patients – and that directly help other people in a similar situation – are that these more recent cases used less intense procedures than for Timothy Brown in 2008. They therefore allow for slightly easier approaches for future cases and the lessons will crossover both for cancer and HIV care.

comment

Having followed this case from the first tentative presentation of the results at a BHIVA meeting in 2018 [11] to the upcoming results due to be presented at CROI 2020 tomorrow, [2]  it is good to be able to report such positive news.

It is clear from the article that by deciding to use his experience as a new advocate, that Adam, the London Patient has a great chance to raise the profile of cure research and HSCT for cancer.

His spirit, resilience and determination to do this publicly are really appreciated.

References

  1. Mandavilli A. The London Patient, cured of HIV, reveals his identity. New York Times. (9 March 2020).
    https://www.nytimes.com/2020/03/09/health/hiv-aids-london-patient-castillejo.html
  2. Gupta RK et al. Sustained HIV remission in the London Patient: the case for an HIV cure. CROI 2020, 8 – 11 March, 2020. Late breaker poster abstract 346LB.
  3. Collins S. UK patient likely to be the second person cured of HIV: two further cases at CROI 2019 of HIV remission after allogenic stem cell transplants. HTB (12 March 2019).
    https://i-base.info/htb/35767
  4. Gupta RK et al. Sustained HIV-1 remission following homozygous CCR5 delta32 allogenic HSCT. CROI 4 – 7 March 2019, Seattle. Late breaker oral abstract 29 LB.
    http://www.croiconference.org/sessions/sustained-hiv-1-remission-following-homozygous-ccr5-delta32-allogenic-hsct
     (abstract)
    http://www.croiwebcasts.org/console/player/41065
     (webcast)
  5. Gupta RK et al. HIV-1 remission following CCR5Δ32/Δ32 haematopoietic stem-cell transplantation. Nature. 2019 Apr;568(7751):244-248. doi: 10.1038/s41586-019-1027-4. Epub 2019 Mar 5.
    https://www.ncbi.nlm.nih.gov/pubmed/30836379
  6. Jensen B-E O et al. Analytic treatment interruption (ATI) after allogeneic CCR5-d32 HSCT for AML in 2013. CROI 4 – 7 March 2019, Seattle. Late breaker oral abstract 394 LB.
    http://www.croiconference.org/sessions/analytic-treatment-interruption-ati-after-allogeneic-ccr5-d32-hsct-aml-2013 (abstract)
  7. Collins S. Stem cell transplant from HLA-matched CCR5-delta 32 deleted donor suppresses viraemia in recipient for 8 months without HAART. HTB (01 April 2008)
    https://i-base.info/htb/1819
  8. Hutter G et al. Treatment of HIV-1 infection by allogeneic CCR5-D32/D32 stem cell transplantation: a promising approach. 15th CROI, 2–6 February 2008. Poster abstract 719. (Abstract no longer online, later published in NEJM [9]).
  9. Hutter G. et al. Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation. N Engl J Med 360, 692-698, doi:10.1056/NEJMoa0802905 (2009).
    https://www.nejm.org/doi/full/10.1056/NEJMoa0802905
  10. Timothy Ray Brown (January 12, 2015). I am the Berlin patient: a personal reflection. AIDS Research and Human Retroviruses. 31(1): 2-3. doi:10.1089/aid.2014.0224.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287108
  11. Collins S. Second case of potential HIV eradication. HTB (19 October 2018)
    https://i-base.info/htb/35132

Links to other websites are current at date of posting but not maintained.