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第二个病人的艾滋病毒缓解

2019年3月5日

A second person has experienced sustained remission from HIV-1 after ceasing treatment, reports a paper led by researchers at UCL and Imperial College London.

艾滋病毒出芽

该病例报告发表于 自然 and carried out with partners at the University of Cambridge and the University of 牛津大学, 这是第一例此类案件发生10年后的事了, 被称为“柏林病人”.’

Both patients were treated with stem cell transplants from donors carrying a genetic mutation that prevents expression of an HIV receptor CCR5.

The subject of the new study has been in remission for 18 months after his antiretroviral therapy (ARV) was discontinued. The authors say it is too early to say with certainty that he has been cured of HIV, 并将继续监测他的情况.

“At the moment the only way to treat HIV is with medications that suppress the virus, which people need to take for their entire lives, posing a particular challenge in developing countries,该研究的主要作者说, 拉文德拉·古普塔教授(UCL感染学院) & 豁免权,UCLH和剑桥大学).

“Finding a way to eliminate the virus entirely is an urgent global priority, but is particularly difficult because the virus integrates into the white blood cells of its host.”

关闭 to 37 million people are living with HIV worldwide, 但只有59%的人接受了抗逆转录病毒治疗, 以及耐药艾滋病毒越来越令人担忧. Almost one million people die annually from HIV-related causes.*

The report describes a male patient in the UK, 谁愿意保持匿名, and was diagnosed with HIV infection in 2003 and on antiretroviral therapy since 2012.

Later in 2012, he was diagnosed with advanced Hodgkin’s Lymphoma. 除了化疗, he underwent a haematopoietic stem cell transplant from a donor with two copies of the CCR5 Δ32 allele in 2016.

CCR5 is the most commonly used receptor by HIV-1.** People who have two mutated copies of the CCR5 allele are resistant to the HIV-1 virus strain that uses this receptor, 因为病毒不能进入宿主细胞.

Chemotherapy can be effective against HIV as it kills cells that are dividing. Replacing immune cells with those that don’t have the CCR5 receptor appears to be key in preventing HIV from rebounding after the treatment.

The transplant was relatively uncomplicated, but with some side effects including mild graft-versus-host disease, a complication of transplants wherein the donor immune cells attack the recipient’s immune cells.

The patient remained on ARV for 16 months after the transplant, at which point the clinical team and the patient decided to interrupt ARV therapy to test if the patient was truly in HIV-1 remission.

Regular testing confirmed that the patient’s viral load remained undetectable, and he has been in remission for 18 months since ceasing ARV therapy (35 months post-transplant). The patient’s immune cells remain unable to express the CCR5 receptor.

He is only the second person documented to be in sustained remission without ARV. 第一个, 柏林病人, also received a stem cell transplant from a donor with two CCR5 Δ32 alleles, 但是为了治疗白血病. Notable differences were that 柏林病人 was given two transplants, 并进行全身照射, while the UK patient received just one transplant and less intensive chemotherapy.

Both patients experienced mild graft-versus-host disease, which may also have played a role in the loss of HIV-infected cells.

“By achieving remission in a second patient using a similar approach, we have shown that 柏林病人 was not an anomaly, and that it really was the treatment approaches that eliminated HIV in these two people,古普塔教授说.

The researchers caution that the approach is not appropriate as a standard HIV treatment due to the toxicity of chemotherapy, but it offers hope for new treatment strategies that might eliminate HIV altogether.

“继续大阳城娱乐App下载的研究, we need to understand if we could knock out this receptor in people with HIV, 基因疗法有哪些可能呢,古普塔教授说.

“The treatment we used was different from that used on 柏林病人, 因为它不涉及放疗. Its effectiveness underlines the importance of developing new strategies based on preventing CCR5 expression,” co-author Dr Ian Gabriel (Imperial College Healthcare NHS Trust).

“While it is too early to say with certainty that our patient is now cured of HIV, and doctors will continue to monitor his condition, the apparent success of haematopoietic stem cell transplantation offers hope in the search for a long-awaited cure for HIV/AIDS,” Professor Eduardo Olavarria (Imperial College Healthcare NHS Trust and Imperial College London).

这项研究由威康基金会资助, 医学研究理事会, 艾滋病研究基金会, and National Institute for Health Research (NIHR) Biomedical Research Centres at University College London Hospitals, 牛津大学, 剑桥和帝国.

The research team is presenting the findings today (March 5) at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

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  • HIV在淋巴细胞(免疫细胞)上萌发. 信贷:C. 金匠,来源: 维基共享

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