A potential first French case of remission of an HIV infection after an allogeneic bone marrow transplant has been announced by the public hospitals of Marseille (AP-HM). Transplanted in 2020, she stopped her antiretroviral treatments in 2023. Internationally, this would be the eighth case of functional cure for HIV.
Aged around sixty, the patient, diagnosed with HIV in 1999, developed acute myeloid leukemia in 2020, reports the AP-HM in a press release. To treat it, she received an allogeneic bone marrow transplant in July 2020 at the Paoli-Calmettes Institute. The donor had a rare genetic mutation (Delta 32) in the CCR5 gene, “preventing HIV from entering cells”he is reminded. For six of the seven other cases of remission reported worldwide after this type of allograft, the donors carried the same Delta 32 mutation. “The case of the patient whose donor did not carry this mutation suggests that the allograft process alone could contribute to the destruction of the HIV viral reservoir”advances the AP-HM.
After the transplant, the Marseille patient was treated with antiretrovirals for three years. “ The patient stopped her treatment in October 2023, with a strategy of monitoring her virological and immunological parameters, first weekly, then bimonthly and now monthly. To date, all results have remained negative! “, details the Dr Sylvie Bregigeon, director of the team at the Human Immunodeficiency Information and Care Center (CISIH) at Sainte-Marguerite hospital, in Marseille, who is monitoring the patient.
An improvement in immune defenses
Its monitoring included in particular “ultrasensitive viral load tests, viral culture tests as well as pro-viral DNA testing”specifies the AP-HM. Today, “sCD4+ T lymphocyte count increased from 250 to 1,289/mm3 at the last check, normal values were between 650 and 1,500/mm3 environ », welcomes Dr Bregigeon.
-This progress is not “generalizable to all patients affected by HIV”insists the AP-HM. Allogeneic bone marrow transplantation involves a “very heavy conditioning with intensive chemotherapy, radiotherapy, long hospitalization in sterile rooms… only possible and justifiable in the context of the treatment of a hematologic malignancy such as lymphoma or leukemia”he is reminded. Cases of remission remain opportunities to better understand the functioning of HIV and open up “new research perspectives”.
The results of the Marseille case have already been presented at the congresses of theInternational Aids Society in Munich in July 2024 andHIV Drug Therapy in Glasgow in November 2024.” We will soon collaborate with a Parisian team to carry out additional immunological examinations before publication of this clinical case”says Dr. Bregigeon.
