At Sainte-Marguerite hospital, a patient who has been HIV positive since 1999 is in remission one year after stopping her treatments. A first in France and hope for HIV research.
Marseille, once again, proves that it is at the forefront of the great challenges of medicine. On January 13, the AP-HM relayed the story of an unprecedented case in France, and on January 8e in the world: a patient who has been HIV positive for more than twenty years is now in functional remission from HIV. A year after stopping his treatment, no trace of the virus was detected in his body.
“Our patient is obviously delightedconfides Dr. Sylvie Brégigeon, head of the CISIH (Information and care center for human immunodeficiency and viral hepatitis) at Sainte-Marguerite hospital, where the patient was treated. We are talking about a potential case of cure, but further follow-up remains necessary to consolidate these results. »
This is a major breakthrough in the fight against HIV, marked by a bone marrow transplant carried out in 2020 as part of the treatment of leukemia. The transplant, associated with a rare genetic mutation of the donor, opens new scientific perspectives, although this method is not applicable on a large scale.
A transplant and an extremely rare genetic mutation
It all started in February 2020. Diagnosed with acute myeloid leukemia, this patient in her sixties, already followed for two decades for her HIV infection, found herself faced with a double battle.
The doctors at the Paoli-Calmettes Institute, in charge of his case, then decided to try an allogeneic bone marrow transplant. A risky but necessary procedure to treat his leukemia. The team finds a donor who is not only compatible, but also carries an extremely rare genetic mutation: the Delta32 deletion on the CCR5 gene. This mutation blocks the entry of HIV into cells, making individuals carrying both copies of this gene resistant to infection.
“This mutation offers a real shield against HIV,” explains a member of the medical team. To date, only seven patients worldwide have experienced a similar remission thanks to this mutation combined with transplantation.
Three years under close surveillance
After the transplant, the patient is placed on antiretroviral treatment for almost three years, time for her body to stabilize. Under the supervision of Dr Olivia Zaegel-Faucher, ultrasensitive virological tests are carried out in collaboration with the Timone virology laboratory. The results are unequivocal: no trace of the virus.
In October 2023, a collective decision was made: to suspend the treatments. Since then, the patient has been closely monitored with regular virological examinations. To date, all results remain negative.
Even more impressive, his level of CD4+ T lymphocytes, these white blood cells destroyed by HIV, increased from 250/mm³ to 1,289/mm³, a value higher than normal.
A breakthrough for new therapeutic avenues
The story, as exceptional as it is, remains an isolated case. Allogeneic bone marrow transplantation is a protocol reserved for serious pathologies such as leukemia. The procedure involves intensive chemotherapy, radiotherapy and long months of hospitalization in a sterile room.
“This strategy is unfortunately not reproducible for all patients living with HIV,” recognizes Dr. Sylvie Brégigeon. But these rare cases shed light on mechanisms that are still poorly understood and find new therapeutic avenues.
This success is part of the history of the CISIH at Sainte-Marguerite hospital, a pioneering platform in HIV care in France. For more than 30 years, this center has combined care, clinical research and innovation in partnership with the ANRS (National AIDS Research Agency), with follow-up of around 1,200 patients.
This expertise makes Sainte-Marguerite hospital a pioneer, not only in care, but also in contributing to international congresses, such as those in Munich and Glasgow in 2024, where the patient’s case was presented to the scientific community.
The Marseille patient joins a very small circle of patients around the world who have experienced functional remission of HIV. “We will soon collaborate with a Parisian team to deepen the immunological analyzes and publish this clinical case,” adds Dr. Brégigeon.
N.K.
