A woman in New York has been able to stop taking antiretroviral treatments for HIV, and has maintained an undetectable viral load for fourteen months, after undergoing stem cell treatment.
News of the case was shared at the Conference on Retroviruses and Opportunistic Infections (CROI 2022).
The woman, who received the stem cell transplant to treat leukaemia, is doing well, and both her cancer and HIV are in remission. While it is too soon to declare for certain that she is cured of HIV, experts are hopeful that the ‘New York patient’ will join the ‘Berlin patient’ and the ‘London patient’ as the third person to be free of HIV over the long term after stem cell transplantation.
However, they caution that this is a risky procedure that is not applicable to most people living with the virus.
“This third case of an HIV cure post-bone marrow transplant from a donor naturally resistant to HIV, and the first in a woman living with HIV, is a very exciting finding,” said Professor Sharon Lewin, president-elect of the International AIDS Society. “A bone marrow transplant is not a viable large-scale strategy for curing HIV, but it does present a proof of concept that HIV can be cured.”
Previously two people have managed to progress to living without any detectable HIV in their system, while abandoning the use of antiretroviral medications.
The first man to be cured, Timothy Ray Brown, formerly known as the Berlin patient, received two stem cell transplants to treat acute myeloid leukemia in 2006. At CROI 2019, researchers described a second man, Adam Castillejo, dubbed the London patient, who also achieved long-term HIV remission after a stem cell transplant to treat Hodgkin lymphoma.
Castillejo has maintained being HIV free for four years, and there has not been a reoccurrence of his leukemia. Sadly Timothy Ray Brown died in 2020 after his leukemia returned, he lived without HIV for 14 years.
Scientists later discovered why the bone marrow transplant the two men received for their leukemia was also effective in combatting HIV, both donors had a rare genentic mutation.
AIDSMAP.com explained the details of the case.
Professor Yvonne Bryson of the University of California Los Angeles described the new case at the conference and an accompanying press briefing.
The middle-aged (post-menopausal) woman, a participant in an observational study called IMPAACT P1107, was diagnosed with HIV in 2013 and acute myeloid leukaemia in 2017 and she required a stem cell transplant.
The study was designed to use previously screened umbilical cord blood with the double CCR5-delta-32 mutation, which is present in only around 1% of northern Europeans and is even rarer in other populations.
Being of mixed race, the woman’s chances of finding an adult donor who was both a close genetic match and carried the double mutation were slim, especially given that people of colour are underrepresented in bone marrow donor registries.
Cord blood is more “forgiving” and does not require such a close genetic match as adult stem cells, Bryson explained, but the volume of banked cells is too small for an adult transplant and cord cells are slower to engraft, or become established in the body.
Instead, doctors at Weill Cornell Medical Center performed a new procedure known as a haplo-cord transplant, which combined CCR5-delta-32 cord blood cells with partially matched adult donor stem cells from one of the woman’s relatives without the CCR5 mutation.
The adult donor cells provide enough volume and faster engraftment, shoring up the immune system and giving the cord blood cells more time to get established. Like Timothy Ray Brown, the woman received intensive chemotherapy and whole-body radiotherapy prior to the transplant.
The transplant went well and the woman did not develop graft-versus-host disease, which is less common with cord blood. Within 100 days, she achieved full engraftment with 100% CCR5-delta-32 immune cells derived from the cord blood cells. “She basically had a new HIV-resistant immune system,” Bryson said.
The woman remined on antiretroviral treatment for three years after he transplant treatment, while researchers monitored the growing number of HIV resistant cells in her body. Fourteen months after stopping taking the antiretroviral treatment she remains HIV free and her leukemia is also in remission.
Researchers have stressed that cases like these do not provide a scalable treatment for other people living with HIV, and the situation only arises in a very small number of people. It does however show that it is possible that the latent HIV reservoir can be cleared enough to produce durable remission, and offers clues that could lead to a more widely applicable treatment options.
OIP Staff
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