Third transplant patient cured of HIV signs Important firsts

February 16, 2022 — This week’s news that a third person has been “cured” of HIV with a unique stem cell transplant has given hope for a larger-scale way to stem the HIV epidemic that has plagued the world for decades.

But while this case is certainly cause for celebration, experts involved in the effort say we’re still a long way from a universal cure.

Researcher Yvonne Bryson, MD, chief of pediatric infectious diseases at UCLA, told those attending an infectious disease conference on Tuesday that this is a special case. The patient was a woman with HIV who is multiracial. The previous two patients were male: one white, one Latino.

The woman in this case received transplants of stem cells and cord blood to treat leukemia. The treatment not only put her cancer in remission, but also her HIV.

The success of this case suggests that umbilical cord stem cell transplants should be considered to induce remission and cure for people with HIV who also have cancer and other diseases, the researchers say.

While the news was received with excitement in the scientific community, the approach will not be universally available, as the transplants were all done to treat cancer in the three HIV-infected patients. Overall, Bryson estimates that about 50 people per year can benefit from this procedure.

Still, other experts say the approach could provide insight into other ways to find a cure. And Bryson says it opens up options for more diverse populations.

“Bone marrow transplant is not a viable large-scale HIV cure strategy, but it does provide proof of concept that HIV can be cured,” said Sharon Lewin, MD, president-elect of the International AIDS Society. “It also bolsters the use of gene therapy as a viable HIV cure strategy.”

The woman needed a stem cell transplant after being diagnosed with leukemia, a blood cancer. The stem cell transplant technique used was also new, Bryson says. The medical team used a combination of adult stem cells from a family member’s blood and cord blood from an umbilical cord blood bank containing a rare mutation that makes the immune system resistant to HIV.

In the previous two cases of HIV cure after transplantation, both patients were treated with stem cell transplants, with the same mutation, but with bone marrow transplants, a more difficult procedure. And no cord blood was used for that.

The combination of adult cells and umbilical cord blood cells proved to be the gateway to success. Using the mature cells creates a kind of bridge that helps until the umbilical cord blood takes over, the researchers say. By day 100 after the transplant, Bryson says, the woman actually had a new immune system.

HIV remained undetectable in T cells and in bone marrow. And 37 months after the transplant, the woman stopped taking the antiretroviral treatment usually given to treat HIV infection.

“She is currently clinically good,” Bryson says. Her cancer is also in remission.

Case histories: three patients

The woman, who is middle-aged, has asked for privacy and requested not to disclose her age or other details. But the researchers did provide some background on her medical history and her path back to health. In 2013, she was diagnosed with HIV and started treatment with antiretroviral therapy (ART). Four years after her HIV diagnosis, she developed high-risk acute myeloid leukemia, a blood cancer. The transplant was done to treat that.

Her recovery was much less bumpy than that of the previous two patients, the researchers say. She left the hospital 17 days after the transplant. She had no serious complications like the first two, which developed a condition that occurs when donor bone marrow or stem cells attack the recipient.

“This case also suggests that the transplantation of HIV-resistant cells was the key to a cure here,” said Lewin of the International AIDS Society. The first patient to have HIV remission after a stem cell transplant, a white male, remained in remission for 12 years and was named cured, but he died of leukemia in September 2020. The other, a Latino male, has been in remission for over 30 months.

HIV Statistics, Ethnic/Racial Burden

In the US, about 1.2 million people have HIV, according to HIV.gov, although 13% don’t know they have it. In 2019, 34,800 new infections were identified.

Certain ethnic and racial groups are more affected by HIV than others, given their proportion of the US population, federal statistics suggest. For example, in 2019, African Americans made up 13% of the U.S. population but 40% of those living with HIV. Hispanics/Latinos represented 18.5% of the total population, but 25% of those diagnosed with HIV.

Differences also affect women unequally, with black women being disproportionately affected compared to women of other ethnic and racial groups. Annual HIV infections remained generally stable among black women from 2015 to 2019, but federal statistics indicate that the number of new HIV infections among black women is 11 times higher than among white women and 4 times higher than among Latinas.

Expert Perspective, Comments

Vincent Marconi, MD, professor of infectious diseases at Emory University School of Medicine, whose research focuses on differences in responses to HIV treatments, called the news “an exciting development for the cure agenda. This is the first woman to be cured for at least 14 months, and they were using cord blood, which could potentially allow for less toxic regimens and fewer side effects.”

Although the approach, intended to be used to treat the cancers, will not be widely available, he says it “does provide insight into somewhat related alternative medicine to gene therapy.”

Meanwhile, Marconi and other researchers are also focusing on the concept of long-term HIV remission when a cure is not possible. Among the strategies being studied are gene editing and immune system-based treatments. HIV remission is generally defined as having an HIV viral load that is undetectable after stopping treatment.

This post Third transplant patient cured of HIV signs Important firsts

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