Is there new hope for HIV patients?

Adam Castillejo, formerly known as the “London Patient,” recently announced that he has remained cured of HIV for almost 4 years. Previously, Castillejo was considered in remission, now, however, he is the second person to be officially cured of HIV.

Last March, an article in the journal Nature described that a patient with HIV had undergone allogeneic hematopoietic stem cell transplantation (HSCT) for Hodgkin lymphoma from a donor who carried a mutation that impeded the ability of HIV to enter his cells. At that time, Castillejo had been in remission after 34 months without antiretroviral therapy, but doctors were hesitant to call him cured. 

“We think this is a cure now,” said Ravindra Gupta, MD, PhD, who is Castillejo’s virologist. “It’s been another year and we’ve done more tests.”

According to a study published in The Lancet HIV on March 10, 2020, Castillejo is reported to have a healthy CD4 cell count, indicating that he has fully recovered from the transplant. 

In addition, 99% of his immune cells were shown to be derived from the donor’s stem cells, indicating the stem-cell transplant had been successful.

While levels of the virus are undetectable in the patient’s body, there are remnants—or “fossils”—of HIV-1 DNA in his tissue samples. These remnants were also found in the first person to be cured of HIV, and they are unlikely to reproduce the virus.

While bone marrow transplants are not viable as a widespread cure, it is evidence that a cure is possible. 

“It is important to note that this curative treatment is high-risk,” Dr. Gupta said. “[It is] only used as a last resort for patients with HIV who also have life-threatening haematological malignancies. Therefore, this is not a treatment that would be offered widely to patients with HIV who are on successful antiretroviral treatment.”

While most patients are able to manage the virus with current treatment modalities, this news brings welcome optimism to the field of HIV research.

“It’s really important that it wasn’t a one-off, it wasn’t a fluke,” said Richard Jefferys, a director at Treatment Action Group, an advocacy organization. “That’s been an important step for the field.”