First Mestiza Woman to be Successfully Treated for HIV

Doctors say the woman known as the “New York patient” who received a stem cell transplant to treat HIV is now free of the virus and stopped AIDS treatment 30 months ago.

The doctors said that treatment by transplantation of HIV-resistant stem cells from umbilical cord blood has shown successful long-term results.

This approach has been successfully used to treat the “New York patient”, a middle-aged woman with leukemia and HIV who identifies as “mixed-race” and has been infected with HIV since 2017.

“We call it a potential cure, not a cure,” Dr. Yvonne Bryson, director of the Los Angeles-Brazilian AIDS Consortium at UCLA and one of the physicians who handled this matter. We are basically waiting for a longer follow-up period.”

Only a small number of people are cured of HIV, so there is currently no official distinction between treatment and long-term recovery, said Dr. Deborah Perso, acting director of pediatric infectious diseases at Johns Hopkins University School of Medicine. Although the prognosis of the patient from New York is very good, I think we do not want to say now whether she has fully recovered.

Bryson and colleagues released early data on the New York patient in February 2022 and published more details about the case on Thursday, March 16 in a case report in the journal Cell.

The new report covers the patient’s case from the beginning until she stopped taking antiretroviral therapy (ART), the standard treatment for HIV.

The patient received a stem cell transplant in August 2017 and stopped antiretroviral therapy after just over three years.

The use of cord blood stem cells instead of the bone marrow of eligible adults may, as has been done previously, increase the chances of HIV treatment in patients of all ethnic groups.

To be clear, only about 1% of white people have the same CCR5-delta32 mutation, which is rare in other populations.

This rarity limits the possibility of transplanting stem cells carrying a beneficial mutation to patients of color, since stem cell transplantation usually requires a strong match between donor and recipient.

Because it was nearly impossible to find an adult donor compatible with the New York patient’s mutation, the team instead transplanted stem cells carrying the CCR5-delta32/32 mutation from stored cord blood donated by the unrelated child’s parents at birth to try to treat it like cancer. , and HIV human immunity at the same time.

Cord blood cells were injected along with stem cells from a relative of the patient to increase the chances of success.

The transplant successfully cured the patient of HIV and leukemia, a recovery that lasted over four years. Thirty-seven months after the transplant, the patient was able to stop taking her HIV medication.

Doctors who continue to follow her say she tested negative for HIV for more than 30 months after stopping antiretroviral therapy (only 18 months had passed at the time of writing).

Previous HIV treatments, including a definitive cure in men treated in London, Berlin and Düsseldorf, and one long-term recovery in a man treated in Los Angeles, included bone marrow stem cell transplantation as a dual treatment for cancer and HIV. HIV. (The first person to be cured of HIV, a man from Berlin, died in 2020 after a relapse of his cancer.)

All of these transplants used bone marrow stem cells from adult donors carrying two copies of the rare CCR5 delta 32 gene mutation.

This mutation alters the entry that HIV normally uses to enter white blood cells, thus preventing the virus from entering.

After transplantation, donor stem cells actually take over the patient’s immune system, replacing old cells exposed to HIV with new, HIV-resistant cells.

To clear the way for new immune cells, doctors destroy the original population of immune cells with chemotherapy or radiation therapy.

Because cord blood is easier to access than adult bone marrow and easier to match between donors and recipients, such procedures may become more common in the future. However, according to Bryson, stem cell transplantation is not suitable for patients with HIV who do not have a second serious illness, such as cancer, because, according to Bryson, it involves destroying the immune system.

Source: Living Science