Third person living with HIV has been cured by transplant

February 15, 2022 – A woman is in HIV remission for 14 months after being treated for leukemia with adult stem cell and cord blood transplants. If she goes off treatment without any trace of HIV, she would be only the third person in the world — and the first woman — to be cured by a transplant.

“Her own virus couldn’t infect her cells,” says Yvonne Bryson, MD, chief of pediatric infectious diseases at UCLA School of Medicine, who presented the study at an infectious disease conference.

This approach may be available to a more diverse group of people living with HIV. The New York woman, who is biracial and has asked not to share her specific race and age to protect her privacy, was diagnosed with HIV in 2013. transmitting HIV to others, but also gives the virus less time to enter cells, where it can hide.

But in 2017, she was diagnosed with leukemia. As a last resort to cure her of the cancer, she was given a combination of adult stem cells from a family member’s blood and cord blood obtained from an umbilical cord blood bank. That sample of cord blood was selected because it contained a genetic mutation that makes the immune system resistant to HIV.

The two previous HIV treatments, with Timothy Ray Brown from Berlin and Adam Castillejo from London, also used stem cell transplantation with the same mutation. But they had bone marrow transplants. Those transplants are more difficult than cord blood transplants, which are often used to treat cancer in children.

In this case, the doctors treating her used both.

“This allows the mature cells to accelerate and grow until the umbilical cord blood takes over,” said Bryson, who presented the data at the Conference on Retroviruses and Opportunistic Infections 2022. Bryson shared data showing that shortly after HIV diagnosis and treatment, the viral disease spread. load on the patient dropped to undetectable levels. She had a viral peak when she received the transplant, but then it went undetectable again and has remained that way ever since.

Her immune system rebuilt itself using the new HIV-resistant cells supplied with the transplant. The transplant went so well that she was able to leave the hospital early.

One hundred days after the transplant, the immune system in the umbilical cord blood had taken over. After 27 months, she decided to stop all HIV treatments to see if the transplant had worked.

This was the real test. But even when Bryson and colleagues continued to monitor her closely, they found no sign of the disease. She tested negative for HIV.

“Her cells are now resistant to HIV — both her own strains and laboratory strains,” Bryson said in an interview. “It has now been 14 months. She has no rebound and no detectable virus.”

Most donors with the gene mutation this patient received are white, Bryson said, suggesting that, in a multi-racial woman, this approach could expand the pool of people with HIV and cancer who are good candidates.

Now the challenge is to move from a single case to making the medicine available to other people with HIV.

For people living with HIV, especially women of color, the results raise hopes and questions. Nina Martinez knows a thing or two about being a “first.” In 2019, she became the first American woman of color with HIV to donate a kidney to another person living with the virus. For her, the excitement over the first woman of color to be cured of HIV shines a light on how bad white and male HIV cure research has been so far.

“For me, I’m not looking for a cure where the successful step forward is that I get cancer,” she said. “I look at, what is going to be sustainable? I want to know what works for a group of people.”

Gina Marie Brown, a social worker living with HIV in New Orleans, also thinks about groups of people.

“Every time we get a breakthrough, it’s like the sun comes out a little bit more from behind the clouds,” she said.

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