The London Patient is the second ever case of HIV who recovered and remains virus-free to this day, four years since he first underwent the procedure.
Prof. Ravindra Gupta is an Indian-origin British citizen, who also holds overseas citizenship of India. He is a professor of clinical microbiology at the Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, as well as at the Africa Health Research Institute in Durban, South Africa. He recently featured in Time magazine’s list of 100 most influential people in the world. “I was really amazed and pleased when I got to know this. I thought it was a great honour and indeed it was important for a virologist to get such recognition, especially in the times of COVID-19. People now realize how important the role of science and scientists is in society,” says Prof. Gupta.
Prof. Gupta was born in the UK and studied in universities across the UK and the US. He has been dedicated to HIV research over the last decade. “I have always been very fond of travelling, having travelled a lot around India, Asia and sub-Saharan Africa,” says Dr. Gupta. “When the time came to choose my career, I started becoming interested in HIV/AIDS because it was a disease that was prevalent in many countries that I was interested in and had knowledge of. It was a disease that was going out of control, and I wanted to do something about that.” According to the World Health Organization, as of July 2020 HIV/AIDS has claimed nearly 33 million, and at the end of 2019, 38 million people around the world were living with HIV.
There are several drugs recommended by the WHO for treatment of HIV. However, “drugs stop working if people do not take them regularly, a problem scientifically termed as ‘drug resistance’, and I wanted to deal with that,” Dr. Gupta adds. “As a population geneticist, I came into virology research from a population level perspective. At the same time, I was also a practising doctor seeing HIV patients, so I was truly interested in finding a cure. I asked myself: can we remove the virus from the body from where it is hiding? And I came across this individual in London who had a blood cancer called Hodgkin’s lymphoma. Normally you could treat it with chemotherapy to kill the cancer cells but sometimes chemotherapy fails, and in his case it did fail. So, the only option left was to replace this person’s entire blood system with someone else’s blood system, a process called hematopoietic stem cell transplantation. Our patient also had HIV, so it was really an opportunity to clear the cancer and HIV at the same time with a transplant. We had to use a donor with a rare mutation in the gene CCR5, which was known to protect against HIV, in order to give the London patient the chance for an HIV cure. But this is a dangerous procedure, because we really have to destroy the person’s own immune system first before we can give them a new immune system that can fight the cancer and that is resistant to HIV infection.” Luckily for us, and for the London patient, the procedure worked.”
The London Patient is the second ever case of HIV who recovered and remains virus-free to this day, four years since he first underwent the procedure. This marvellous achievement brought Dr. Gupta’s research into the limelight and was in the news a lot at the same time as a major HIV conference last year. It was published in the prestigious scientific journals Nature and more recently in the Lancet.
“Something like this has been done only once before, almost a decade ago in the Berlin patient, from whom we knew that using transplantation we can make a person immune to the disease by using cells from a donor who is naturally resistant to HIV.” Due to a specific genetic mutation in the CCR5 gene, some people are naturally resistant to HIV. The Berlin patient passed away on 30th Septemebr 2020 because his cancer came back, something he was originally treated for using bone marrow transplantation in 2007. He had remained free of cancer and HIV for all these years since then.
Picture for representation only
“While this procedure is too dangerous to be used for many other diseases or for HIV alone, our work showed a pathway that we could use to design safer therapies. And nevertheless, in such a terminal case, the procedure was worth a try,” says Dr. Gupta.
“People have done gene modification of stem cells to correct mutations and treat diseases like thalassemia but ours was the first in terms of changing a gene during a transplant procedure. Many people are now taking the idea of gene editing forward and modifying people’s own cells so that they can change the protein that HIV uses to interact with cells. Our work shows that gene editing might be a way to copy what we did in a safer way. So, you don’t give them a new immune system, but rather, you use their own immune system but just change it a little bit,” Dr. Gupta adds.
“So, I think this is the way forward,” he concludes. His lab is now also busy with COVID-19 research and “we are applying a lot of our expertise in virology from HIV and translating it directly to COVID work,” he says.