A 63-year-old man in Norway seems to have gotten one of the best gifts ever given by a brother: a cure to his lifelong HIV infection.
Doctors detailed the amazing turn of events in a case report out this week. The brother initially donated his stem cells to help treat the man’s life-threatening blood cancer, but he also possessed a rare mutation that grants natural resistance to HIV. Four years after the transplant, and two years after the man stopped antiretroviral therapy, he still appears to be free of the infection.
“For all practical purposes, we are quite certain that he is cured,” Anders Eivind Myhre, one of the man’s doctors, told AFP Monday.
The Oslo patient
Current medications have transformed HIV from a practical death sentence to a manageable health condition. Sustained therapy can even prevent infections from being transmitted to others. Yet HIV remains a lifelong ailment, and trying to stop treatment will usually cause the infection to resurge in a matter of weeks or months.
In recent years, however, doctors have shown it’s possible to eradicate the last remnants of a controlled HIV infection through stem cell transplantation. HIV primarily infects certain white blood cells, and the transplant is intended to effectively rebuild a person’s immune system. The stem cells replace the recipient’s bone marrow, which produces the body’s blood and immune cells.
The people in these cases are typically only identified by where they lived at the time of treatment, though some have later disclosed their identity. As such, doctors have nicknamed the man in this latest case the “Oslo patient.”
According to the report, the man was first diagnosed with myelodysplastic syndrome, a type of cancer that weakens blood cell production from bone marrow, in 2018. Though he seemed to initially respond to treatment, the cancer returned after two years, and doctors decided to perform a stem cell transplant.
Because the man also had HIV (diagnosed in 2006), the doctors were hoping to treat both conditions at once, though they knew their chances were low. Most of these cases have involved the use of stem cells taken from people with two copies of a particular mutation in their CCR5 gene, which regulates the CC5R receptor on white blood cells. This mutation, named CCR5-delta 32, makes immune cells naturally resistant to infection from strains of HIV-1 (the most common type of the virus). However, only about 1% of the population carries two copies of the mutation.
After initial screening failed to find someone who both possessed the mutation and had compatible bone marrow, the doctors decided to move ahead with the man’s brother, who was already known to have compatible bone marrow. But to everyone’s surprise, testing on the day of the transplant showed that the brother also had the mutation.
Though the man did experience some complications from the procedure, his body successfully started to produce new blood cells with the mutation. The doctors decided to take him off antiretroviral medication two years after the transplant. And in the two years since then, regular follow-up tests have failed to show any signs of the virus in his system.
Lessons to be learned
The odds of this case happening are pretty remarkable. Leaving aside the low rate of the mutation in the general population, siblings in general are only a compatible bone marrow match about a quarter of the time. According to AFP, there have only been roughly 10 cases worldwide involving an HIV cure through stem cell transplantation. This is the first to involve a family donor.
It’s no wonder, then, that the Oslo patient feels plenty lucky. The man said that “it was like winning the lottery twice,” Myhre told the AFP.
Sadly, these transplants are not a viable approach for curing HIV en masse. The procedure is incredibly risky and even deadly sometimes, meaning it’s reserved as a last resort treatment for blood cancers that have no other recourse. At the same time, this treatment can certainly give people with both conditions a new lease on life. And there are lessons that doctors and researchers hoping to beat HIV for good can learn from the Oslo patient and others like him.
“The case of the Oslo patient contributes valuable evidence to the existing knowledge base regarding HIV cure cases,” the doctors wrote in their paper, published Monday in Nature Medicine.
