New York: A US woman has reportedly been cured of HIV disease after undergoing stem cell transplant. The woman dubbed as the New York patient is also the third person in the world to be cured of HIV disease, after receiving a stem cell transplant.
The lady is in remission after receiving a new combination of specialised stem cell transplants for the treatment of acute myeloid leukemia (AML), according to researchers at the University of California, Los Angeles. Despite the cessation of antiretroviral therapy (ART), she has had no detectable levels of HIV for 14 months, they said.
‘This woman has been in remission of AML for four and a half years and has had no HIV rebound in the 14 months since antiretroviral therapy was stopped’, said Dr Yvonne Bryson, Professor and specialist in pediatric infectious diseases and HIV pathogenesis at the David Geffen School of Medicine at UCLA. ‘If HIV remission continues and she is determined to be cured, she would be only the third person to achieve cure and the first HIV remission to have been successfully engrafted with umbilical cord blood cells with a mutation that is protective against HIV-1 combined with stem cells from an adult, haploidentical (half-matched) related donor’, Bryson said.
The two previous patients with HIV cure received adult donor cells – one from bone marrow and one from blood stem cells – that had the protective mutation, but no umbilical cord blood cells. The woman is of mixed race who was diagnosed with acute HIV in 2013 and high-risk AML in 2017. She achieved leukemia remission after chemotherapy. Prior to receiving the stem cell transplant, the participant’s HIV was well-controlled but detectable. In 2017, she received a transplant of cord blood stem cells supplemented with adult donor cells from a relative (called haplo cells).
After receiving the stem cell transplant, she engrafted with 100 per cent cord blood cells at day 100 and had no detectable HIV. At 37 months post-transplant, the patient stopped taking ART. According to the study team, no HIV was detected in the participant for 14 months except for a transient detection of trace levels of HIV DNA in the woman’s blood cells at 14 weeks after stopping ART. The haplo cells only transiently engrafted and contributed to rapid recovery.
HIV remission resulting from a stem cell transplant had been previously observed in two cases. The first, known as the ‘Berlin patient’ (a Caucasian male), experienced HIV remission for 12 years and was deemed cured of HIV; he died of leukemia in September 2020. The ‘London patient’ (a Latino male) has been in HIV remission for more than 30 months.
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Although stem cell transplantation is not a therapy for HIV, its effects in patients living with HIV and undergoing therapy for blood or lymph cancers provide researchers with insights and potential targets in HIV treatment. ‘This study provides hope for the use of cord blood cells or a combination of cord blood cells and haploidentical (half-matched) grafts to achieve HIV-1 remission for individuals requiring transplantation for other diseases. It also provides proof that HIV-1 viral ‘reservoirs’ can be cleared sufficiently to afford remission and possibly cure in the setting of resistant target cells’, Bryson said.
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