Fourth ‘Cured’ Patient, Botswana’s 95-95-95 Win Offers New Hope In HIV Fight

Studies highlighted at the AIDS 2022 conference provide insights into new and existing strategies to help end the HIV pandemic.

MONTREAL, July 27 – For the fourth time since HIV/AIDS became a global pandemic, and the second time this year, researchers announced that a fourth patient with HIV, a virus that causes AIDS, appears to have been cured.

The 66-year-old man referred to as the “City of Hope” patient after the medical centre in California, United States, where he received a stem cell transplant more than three years ago, is the fourth known person to go into HIV remission, meaning the virus is suppressed for a period of time by the immune system without the need for antiretrovirals.

He has been off of antiretroviral treatment for HIV for 17 months.

Diagnosed with HIV in 1988 and acute myeloid leukaemia (AML) in 2018, the City of Hope patient is both the oldest person to date and the longest to have lived with HIV to come out successful from a stem cell transplant cure treatment.

“This case may open up the opportunity for older people living with HIV and blood cancer to receive a stem cell transplant and go into remission for both diseases if a donor with this rare genetic mutation can be identified,” Dr Jana Dickter, an infectious disease specialist at the City of Hope, told reporters Wednesday at a pre-conference session at AIDS 2022, the 24th International AIDS Conference, organised by the International AIDS Society (IAS) in Montreal, Canada.

The City of Hope patient, who declined to be identified, said he never thought he would “live to see the day” when he would no longer have HIV.

“When I was diagnosed with HIV in 1988, like many others, I thought it was a death sentence,” he said in a statement. “I am beyond grateful.”

HIV remission resulting from stem cell transplants had been previously reported in two cases

The first case, known as the “Berlin” patient who had AML, was reported in 2009. He was submitted to a bone marrow stem cell transplant and experienced HIV remission for 12 years. He died of recurrent leukaemia in September 2020. 

The second case, known as the “London” patient, a man with Hodgkin lymphoma, was in HIV remission for more than 30 months after a bone marrow stem cell transplant.

Earlier in February, a woman dubbed the “New York” patient became the third known person, and the first female, to be cured of HIV using a new stem cell transplant method. 

The transplant involved cells from the umbilical cord blood which is more readily available than adult stem cells used in bone marrow transplants, the New York Times reported. 

Another Viral Remission Case

Another report presented at the pre-conference was on a 59-year-old Spanish woman with HIV who maintained an undetectable viral load for over 15 years without antiretroviral therapy.

IAS president-elect Sharon Lewin said the case was not quite the same as the City of Hope patient, as the virus remained at a very low level.

This means that unlike the limited group of people who have possibly been cured by stem cell transplants, the Spanish woman still retains the virus which can reproduce.

After receiving antiretroviral and immunomodulatory treatment, including eight weeks of cyclosporine, during primary HIV infection, the woman has maintained undetectable viral load in plasma for more than a decade.

Lewin told reporters last week that it is still difficult to judge whether the treatment the woman received actually caused her state of remission, saying more research is needed to determine if others will also benefit from the same therapy.

“A cure remains the Holy Grail of HIV research,” Lewin said. “We have seen a handful of individual cure cases before and the two presented today provide continued hope for people living with HIV and inspiration for the scientific community.”

Botswana’s 95-95-95 Success

Scientists also announced Botswana as the second nation in the world, after Eswatini, to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets on HIV diagnosis, treatment and viral suppressions.

The target aims for 95 per cent of HIV-positive people to know their status, 95 per cent of those diagnosed on medication, and 95 per cent of those under treatment to show signs that the virus is being suppressed in their blood by 2025.

A population-based survey led by Botswana’s health ministry found the country had already met or surpassed the three thresholds, with a 95-98-98 score. According to the UNAIDS, the global average score in 2020 was 84-87-90.

Since offering free HIV treatment to all citizens, Botswana has expanded treatment coverage and implemented test-and-treat programmes that provide immediate treatment to people who test positive for HIV.

Madisa Mine from Botswana’s Ministry of Health and Wellness described the country as being “well-positioned” to end its HIV epidemic by 2030, despite the fact that approximately one in five adults in Botswana are living with HIV.

“The results from this large-scale survey of Botswana’s progress are truly breathtaking,” Lewin said. “This important milestone demonstrates exactly what evidence-based policies can deliver even in low-income settings.”

Six studies were highlighted during Wednesday’s press conference, including one on doxycycline, a type of antibiotic, that found a 65 per cent reduction in risk of sexually transmitted infections (STIs) – gonorrhoea, chlamydia and syphilis – after condomless sex among men who have sex with men and trans women. 

The other two studies highlighted results of a triple-therapy regimen for people living with both HIV and hepatitis B and a new method using microfluidics to define a biomarker of the HIV reservoir.

The AIDS 2022 conference begins on Friday.

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