Two Brigham and Women's Hospital patients with longstanding HIV infections who underwent bone marrow transplants have stopped anti-retroviral therapy and have no detectable HIV in their blood cells. One patient stopped anti-retroviral therapy 15 weeks ago, the other stopped 7 weeks ago.
These new findings have been presented on July 3, 2013 at the International AIDS Society Conference (IAS 2013) in Kuala Lumpur, Malaysia by Timothy Henrich, MD and Daniel Kuritzkes, MD, physician-researchers in the Division of Infectious Diseases at Brigham and Women's Hospital.
Both patients, who were treated in Boston and had been on long-term drug therapy to control their HIV, received stem-cell transplants after developing lymphoma, a type of blood cancer.
"While these results are exciting, they do not yet indicate that the men have been cured," said Henrich. "Long-term follow up of at least one year will be required to understand the full impact of a bone marrow transplant on HIV
persistence."
Last summer, Henrich and Kuritzkes announced that the virus was easily detected in blood lymphocytes of both men prior to their transplants and became undetectable by eight months post-transplant. However, at the time, the men remained on anti-retroviral
therapy.
Since coming off anti-retroviral therapy this spring, the men continue to have no detectable HIV DNA or RNA in their blood. The men are frequently monitored and researchers have expanded on their prior findings by further examining large volumes of cells, plasma and
tissue.
"We demonstrated at least a 1,000 to 10,000 fold reduction in the size of the HIV reservoir in the peripheral blood of these two patients, but the virus could still be present in other tissues such as the brain or gastrointestinal track," said Henrich. "If virus does return, it would suggest that these other sites are an important reservoir of infectious virus and new approaches to measuring the reservoir at relevant sites will be needed to guide the development of HIV curative
strategies."
Using stem-cell therapy is not seen as a viable option for widespread use, since it is extremely expensive, but the latest cases could open new avenues for fighting the disease, which infects about 34 million people
worldwide.
With Timothy Ray Brown, known as the Berlin patient, who became the first person to be cured of HIV after receiving a bone marrow transplant for leukaemia in 2007, doctor used stem cells from a donor with a rare genetic mutation, known as CCR5 delta 32, which renders people virtually resistant to HIV, while the two Boston patients received cells without this
mutation.
This research is supported by amfAR: The Foundation for AIDS Research, the National Institute of Allergy and Infectious Diseases grants number 1K23AI098480-01A1; UM1 AI068636, P30 AI060354, U19 AI096109 and the Bill and Melinda Gates
Foundation.
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