The London Patient Remains in HIV Remission After 30 Months

Last March at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) meeting in Seattle, Washington, news broke that a second individual had achieved long-term HIV remission. At this meeting it was announced that the absence of viral rebound was observed for 16 months following interruption to antiretroviral therapy at 18 months after a single allogenic CCR5-d32 hematopoietic stem cell transplant.

Headlines about the so-called “London patient” began to spring up and the general public began to wonder are we getting closer to a cure for HIV?

Today, in a virtual session of CROI 2020, 30 month data was presented about the status of the individual. In addition, a paper was published in The Lancet HIV.

The authors of the CROI abstract indicated that ultra-sensitive plasma, semen and cerebrospinal fluid (CSF) viral load assays were used to detect HIV RNA.

In order to quantify HIV-1 DNA the team first mixed tissues samples from gut biopsies and lymph nodes with ceramic beads and Qiagen RLT Plus buffer. Next, the tube contents were homogenized at 6000 rpm for 45 seconds using a MagNA Lyser. From there, genomic DNA was extracted using a Qiagen AllPrep DNA/RNA mini kit. Finally, cell-copy number and total HIV DNA levels were quantified in triplicate using digital droplet polymerase chain reaction (ddPCR).

The abstract authors report that both HIV viral load in plasma and proviral HIV DNA in CD4 cells have remained below levels of detection for up to 30 months.

The most recent data include as CD4 count of 370 cells/UI (20.3) and a CD4/CD8 ratio of 0.65.

According to the abstract, plasma HIV antibodies have remained undetectable by western blot, except for low level Env reactivity.

Additionally, semen viral load was below limit of detection in both plasma (LLD in seminal plasma is <12 copies/ml) and cells (LLD 10 copies/million cells). It was also reported that CSF protein and glucose were normal and HIV viral load in CSF was below detection.

“HIV DNA by ddPCR was negative in rectum, caecum, sigmoid, and T.lleum,” the authors wrote. “Lymph node tissue from the axilla was positive for LTR and Env at around 30 copies/million cells, but negative for packaging signal and integrase. The intact proviral DNA assay was negative.”

After 30 months, the London patient remains in HIV remission. Just 1 day before the data was presented at CROI, the individual came forward and released his identity to the world through an interview with The New York Times. Adam Castillejo, is the second individual to achieve long-term remission of HIV, the first was Timothy Ray Brown, formerly known as the Berlin patient.

“We conclude that this represents HIV-1 cure with evidence of low-level defective HIV genomes in lymphoid tissue,” the authors concluded.

The abstract, Sustained HIV remission in the London patient: the case for HIV cure, was presented virtually on Tuesday, March 10, 2020, in a poster session at CROI 2020.