HIV: 3 things to know about the case of the Geneva resident in remission

A man from Geneva has been declared in remission from HIV, following a bone marrow transplant as part of treatment for blood cancer (leukaemia). The announcement was made at the IAS 2023 International HIV Conference, in Brisbane, Australia.

If five other people in the world are also considered to be in remission, or even cured, this case differs from the previous ones. Indeed, for patients in Berlin, London, Dusseldorf, New York and City of Hope, the bone marrow transplant came from a donor with a genetic mutation (named CCR5 delta 32) making cells naturally resistant to the AIDS virus. Now, here, the patientbenefited from a stem cell transplant which, for the first time, does not present no rare genetic mutation that could explain this remission. What makes it a single case”, specify the University Hospitals of Geneva (HUG) in a communicated.

The bone marrow stem cell transplant was performed in 2018, and the Geneva patient definitively stopped his antiretroviral treatment in November 2021.

According to Prof. Alexandra Calmy, head of the HIV Unit at HUG, and Prof. Asier Sáez-Cirión, head of the Viral Reservoirs and Immune Control Unit at the Institut Pasteur, “the duration of undetectability after discontinuation of treatment – 20 months – did not no precedents in people who have received a bone marrow transplant in the absence of the CCR5 delta 32 mutation”, which is a major step forward. A remission described as “Magic“by this now Geneva patient”future-oriented”, but which must be considered with caution. Because previously, other patients had received stem cell transplants “normal”, and the HIV had reappeared in their organism a few months after stopping the retrovirals.

Here, neither viral particles, nor activatable viral reservoir, nor increased immune responses against the virus in the patient’s organism were identified, suggesting a complete remission.

According to the scientists questioned about this exceptional case, it is possible that the immunosuppressants prescribed to make the body accept the transplant have induces profound immunosuppression and completely emptied the reservoirs of HIV, resulting in this prolonged remission and potential cure.

However, there is no question of seeing in this new remission the promise of a treatment that can be transposed on a large scale to all those carrying HIV, because it is far from trivial. “He is considered as too risky to treat people with HIV who don’t need a transplant. The latter can indeed make them vulnerable to other infections, and the body sometimes rejects the transplant. This discovery, however, opens new perspectives for better understanding – and perhaps one day controlling – the way the virus replicates in the human body.”, we read in the press release of the University Hospitals of Grenoble.

However, this remission remains important for advancing research towards a cure for HIV.

In the morning of France Inter this Friday, July 21, Yazdan Yazdanpanah, infectiologist and director of the ANRS/Emerging Infectious Diseases Agency, as well as Christophe Martet, president of the association Vers Paris sans sida, estimated that in parallel with basic research, it is crucial that all people currently living with HIV are detected as soon as possible and receive the treatments that already exist. Which allow you to live with HIV, make it undetectable and stop transmitting it.