“Our patient is obviously delighted. » In Marseille, the Sainte-Marguerite Hospital announced on Friday January 17 an exceptional case of HIV remission, 42 years after the discovery of the virus responsible for AIDS. A huge success, made possible by a bone marrow transplant carried out five years ago.
1. How is this a first?
This is the very first case of a potentially cured HIV patient in France. And the eighth in the world thanks to a bone marrow transplant, after cases of remission in Germany, the United Kingdom, the United States and Switzerland.
2. Who is the patient?
Aged around sixty, the patient was diagnosed with HIV in 1999. She was treated with antiretrovirals and her viral load had become “undetectable”. What was not healing: “Indeed, there always remain traces or fragments of latent virus capable of reactivating. This is why HIV is a chronic, persistent infection that normally requires lifelong treatment.underlines Professor Sylvie Bregigeon, who directs the CISIH (Information and Care Centers for Human Immunodeficiency), quoted in a press release from Marseille public hospitals (AP-HM)
But ten years later, in 2020, the patient developed acute myeloid leukemia – a cancer affecting the blood and bone marrow cells. Supported at the Paoli-Calmettes Institute in Marseille, she then received a transplant.
3. What is special about the donor?
As Sylvie Bregigeon points out, “the team from the Paoli-Calmettes Institute managed to find a donor who was not only compatible but also presented a particularity sought in this type of case”a very rare genetic mutation called Delta32. This mutation affects a gene (CCR5) which is “used by the HIV virus as an entry point into the cells of people it has infected”. Clearly, this mutation results in the ability to never contract HIV.
The transplant helped treat the leukemia, and the patient continued her antiretroviral treatment for three years. Virological examinations showed the disappearance of all traces of HIV. So much so that in October 2023, the patient was able to stop her antiretroviral treatment, while remaining under strict observation. The verdict? “To date, all results have remained negative! “, rejoices Sylvie Bregigeon. In addition, the level of white blood cells targeted by HIV has returned to normal. “We can already talk about remission of HIV infection and a potential cure. »
-4. Is this case generalizable?
No, such treatment cannot be generalized to all HIV patients, due to the cumbersome nature of the treatments. Even if the patient from Marseille “doing very well today”, according to the doctor who followed her in her department, Olivia Zaegel-Faucher, “All the monitoring and management of her leukemia since 2020 have been very difficult years for her because the treatments have been very heavy.” The patient went to intensive care and suffered several infectious complications, said Olivia Zaegel-Faucher, interviewed by the AIDS association, Aides.
The AP-HM emphasizes that “this strategy involves very heavy conditioning with intensive chemotherapy, radiotherapy, long hospitalization in sterile rooms…” Treatments “only possible and justifiable in the context of the treatment of a hematologic malignancy such as lymphoma or leukemia. »
5. Is this a hope?
These cases of remission allow a more detailed understanding of how HIV works. “They greatly contribute to opening new research perspectives”note the Marseille doctors. They point out that in six of the seven other cases reported worldwide, the bone marrow donor carried the same genetic mutation.
Read also: MAINTENANCE. “Preventive treatments could defeat HIV,” recalls this doctor
In 2023, 39.9 million people worldwide were living with HIV, according to UNAIDS. Even though the end of the epidemic remains distant, new human immunodeficiency virus infections have fallen to their historic low, around 1.3 million people per year.
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