A man has become the seventh person to be left HIV-free after receiving a stem cell transplant to treat blood cancer. Significantly, he is also the second of the seven who received stem cells that were not actually resistant to the virus, strengthening the case that HIV-resistant cells may not be necessary for an HIV cure. "Seeing that a cure is possible without this resistance gives us more options for curing HIV," says Christian Gaebler at the Free University of Berlin. Five people have previously become free of HIV after receiving stem cells from donors who carried a mutation in both copies of a gene encoding a protein called CCR5, which HIV uses to infect immune cells. This led scientists to conclude that having two copies of the mutation, which completely removes CCR5 from immune cells, was crucial for curing HIV. "The belief was that using these HIV-resistant stem cells was essential," says Gaebler.
Scientists have generally thought that such cures relied on any virus lurking in the recipient's remaining immune cells -- following chemotherapy -- being unable to infect the donor cells, meaning it can't replicate. "Essentially, the pool of host cells to infect runs dry," says Gaebler.
But the latest case suggests that, instead, cures can be achieved as long as non-resistant donor cells are able to destroy any of the patient's remaining original immune cells before the virus can spread to them, speculates Gaebler. Such immune reactions are often driven by differences in the proteins displayed on the two sets of cells. These make the donor cells recognise residual recipient cells as a threat to eliminate, says Gaebler.
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