How a 4th Person Was ‘Cured’ of HIV After Stem Cell Treatments

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Interesta fourth person has achieved long-term remission of HIV after receiving successful stem cell treatments.
• A 66-year-old man who was living with HIV and leukemia is now in remission from both the virus and blood cancer following a successful stem cell transplant from a donor who possesses an extremely rare genetic mutation.
• He is the fourth person in the world to achieve long-term remission of HIV.
• While his case and course of treatment are very specific to individuals living with the virus and blood cancers, researchers say it’s an important development in the treatment of HIV.
In July, cancer research and treatment center City of Hope presented research at the 2022 International AIDS Conference that shed a positive spotlight on the continued push to better understand, treat, and combat HIV.
The news reverberated around the world — the 66-year-old patient, who wishes to remain anonymous, is the oldest individual to achieve remission from both HIV and leukemia, following a successful stem cell transplant from a donor who possesses an extremely rare genetic mutation.
He is just the fourth person in the world to achieve long-term remission of HIV. While his case and course of treatment are very specific to individuals living with the virus and blood cancers, researchers say it’s an important development in the long winding road to better tackling HIV.
In the course of this man’s adult life, he has seen quite an evolution, from his initial diagnosis of HIV in 1988 at the height of the global AIDS crisis, to today, being in remission for over a year.
The case of the ‘City of Hope patient’
“The most significant finding from this study was the outcome. ‘The City of Hope patient’ achieved dual long-term remission from HIV and acute leukemia after his stem cell transplant using stem cells from a donor who carries the homozygous CCR5 delta 32 mutation, and his experience is unique from his predecessors,” said Dr. Jana K. Dickter, City of Hope associate clinical professor in the Division of Infectious Diseases, who presented the data on the patient at the international conference.
“He is the oldest person to receive a stem cell transplant and go on to achieve dual remission,” she added.
Dickter told Healthline this man especially stands out from his predecessors given he lived the longest with HIV at the time of his stem cell transplant and received the “least immunosuppressive regimen” prior to transplantation.
“The results of this research are profound for people living with HIV and blood cancers for a few reasons. As people continue to live longer with HIV thanks to antiretroviral therapy, they are also at an increased risk of developing blood cancers and stem cell transplantation may be a good option for them to treat their cancer,” she explained. “We now have evidence that some HIV patients with blood cancer may not need as intensive immunosuppressive therapies prior to transplant to put them in remission for their HIV.”
Dickter added that this case shows if clinicians can find the correct stem cell donor, they can “potentially use newer, more advanced and less intense chemotherapy regimen options that are better tolerated for older patients” in addition to the hope that there is potential for dual remission from both diseases for these specific patients.
The research on this man’s specific case was presented on July 27 at the conference and revealed that this man received his transplant nearly three and a half years ago at City of Hope, according to a press release.
His case required a very specific stem cell transplant.
He was living with acute myelogenous leukemia, a type of the disease that appears more often in people living with HIV later in life. The rare genetic mutation — homozygous CCR5 delta 32 mutation — found in the volunteer donor actually makes those who have it resistant to most strains of HIV infection.
CCR5 serves as a receptor on CD4+ immune cells, and attracts HIV as a potential entryway to hit a person’s immune system. What happens is the mutation actually puts up a roadblock to that entry point, preventing HIV from replicating, the release reads.
Finding the right donor for someone like this patient can be marked by an exhaustive search, and from there, the stem cell transplant itself can be an arduous process that can result in serious health complications.
This man received three different therapies to get him to achieve remission from his leukemia before receiving his transplant. For comparison, most people in his position achieve remission after a sole therapy.
The genetic mutation needed for a donor match for this particular patient is found in only 1 to 2% of the population at large. The procedure was a success, and City of Hope revealed that he did not show signs of serious medical issues after the transplant.
Dr. Joseph Alvarnas, professor, Department of Hematology & Hematopoietic Cell Transplant and vice president for government affairs at City of Hope, told Healthline that immense research and work goes behind making these kinds of stem cell matches between donor and patient.
After ruling out direct relatives who might be a match, researchers turn to Be the Match, which collaborates with registries globally. It is touted as the world’s largest and most diverse registry of potential blood marrow donors, reaching 25 million potential donors, as of a 2015 announcement.
Alvarnas said that this case underscores how important it is to do targeted donor searches for this kind of mutation.
“The patient that we are discussing is really important, because as we go to screen patients in the future, this idea that we will also be seeking a donor with the CCR5 delta 32 mutation, for instance,” he said. “It should become more a part of what we do on a routine basis.”
When it comes to this man, Alvarnas said he developed myelodysplastic syndrome, what he called a “pre-leukemia, a change in the blood, a malignancy that over time can evolve toward acute leukemia.”
“That particular illness is not curable without a blood and marrow transplant from a donor. For this individual it is a disease that is even higher risk, meaning they not only started with myelodysplastic syndrome but developed leukemia. That leukemia was pretty tough to treat in that it took three different lines of leukemia therapy to help get him into remission sufficient enough to be able to undergo transplantation,” Alvarnas explained.
“For patients like these, we always worry about the specter of whether or not the leukemia can be potentially resistant to the combined effects of the medicine they get prior to the transplant as well as the immunological effects of the donor’s immune system upon the leukemia, which is what we mean by a risk of relapse.”
“So, for this person, miracle number one is being cured of a life threatening disease — that’s the leukemia derived from myelodysplastic syndrome,” he added. “The other amazing thing is the fact that in the context of delivering life-saving care, you can add another level of transformational value to that person’s life.”
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