Curing people of HIV
The first person cured of HIV was in 2010. Sadly “The Berlin Patient” who's real name was Timothy Ray Brown, died this year after the cancer for which he received his curative stem cell transplant returned. But, in the last few years, another person, dubbed the London patient, has been cured of HIV. His name is Adam Castillejo, and he joined Adam Murphy to tell his story, then Adam Murphy spoke to Ravi Gupta, the doctor who cured him, about the science behind the cure...
Adam Castillejo - My story began in 2003 when I was diagnosed with HIV. It was very traumatic at that time. And then by 2011, 2012, I was diagnosed with cancer. A very different sentence, as I always call it. It was very challenging both times. At the time I struggled quite a lot until 2015. My chemotherapy regimes unfortunately were unsuccessful, time after time. And my only choice was to have a stem cell transplant, but the problem is, and I think it's important to people to understand, it's very complex when you're an HIV person to be able to go for a stem cell transplant. So I had the opportunity, and I will always be eternally grateful for it, by the team at Hammersmith together with Professor Gupta to offer me the possibility to have a stem cell transplant from an unrelated donor in 2016. And for me, as I say, I won the lottery. I couldn't believe it. I will be able to be cured not only for my cancer, not only my HIV. And that came out about 2017. I decided together with Professor Gupta and my medical team to stop my retroviral medication, as Professor Gupta was explaining earlier how complex this virus is. By 2017, I stopped my medication and we took very cautiously the approach to wait, because I mentioned about, as I call him my big brother, Timothy Ray Brown who sadly passed away this year. You know we have to be cautious about early rebounds. By 12 months we were able to say, oh, I think this is very promising, it looks like it's not going to rebound. By early 2019, we decided it was time to show the world it's not only Timothy Brown, it can be replicated. In 2020 I decided to rebuild my name, to share my story of hope.
Adam - And it’s such an incredible story. How are you doing now?
Adam Castillejo - I'm doing okay. I try my best to cope with, as you know, a post-transplant life. As well with the COVID 19. So you have to keep kind of extra cautious or careful about things. I always keep my head positive and thankful for what happened to me. And I try to help and try to keep, you know - I feel like being positive helps me to cope with life. And I think that was one of my main tragedies, and last time I'm keeping this way, keeping going that way.
Adam - Brilliant. It's such a great story. Now we've also still got Ravi Gupta who was the doctor who treated Adam. So how do we know that Adam is actually cured?
Ravi - The answer to that is a difficult one because his absence of HIV has only been determined by looking very deep into blood cells for integrated HIV or even signs of HIV - genetic material. All of our tests came back negative, but it was interesting, after some exploration, we did find fossils of HIV genetic material. The material wasn't capable of making new viruses, it was little fragments. That's not unexpected in fact, and it was also found with the Berlin patient. So we used very sensitive methods, both in blood and in tissues to explore the possibility that there was HIV left behind. But as I said, we couldn't find any evidence that there was any virus capable of making new copies of itself.
Adam - And then is this something that could be rolled out on a wider scale?
Ravi - Of course, the big problem here is number one, that the two cures we've described required chemotherapeutic regimens in order to destroy HIV infected cells. And so those drugs come with side effects and they make you vulnerable to opportunistic infections. So there is a risk attached to them. The second problem of course, is you have to find a tissue match with a donor who has the CCR5 deletion. And that's the second problem because of course, as I said, it's very rare and it's only in Northern Europeans in general. So there were two major barriers to this - the safety of using chemotherapeutic drugs and transplant, and secondly, the donor matching. So what we believe is that this is proof of principle that really we can cure patients. And that was a really important thing because the Berlin patient happened and for 10 years we were not able to replicate it. So the good news is that this is a real thing. The next step is finding ways to get there safely and CCR5 gene therapy is one avenue that started being explored to modify CCR5 in individuals who have HIV in order to explore whether that can help elicit or induce remission and cure.