A US research team reported possibly curing HIV in a woman for the first time. Building on previous successes, as well as failures, in the field of HIV cure research, these scientists used a cutting-edge stem cell transplant method that they hope will expand the pool of people who could receive a similar treatment to several dozen a year.
The “New York patient,” as the woman is called, because she received her treatment at New York-Presbyterian Weill Cornell Medical Center in New York City, was diagnosed with HIV in 2013 and leukemia in 2017. .
The procedure used to treat the New York patient, known as a haplocordon transplant, was developed by the Weill Cornell team to expand cancer treatment options. However, now it has become a new hope against HIV.
The woman received blood from an umbilical cord to treat her cancer. The stem cells come from a partially matched donor, rather than the typical practice of a bone marrow donor of similar race and ethnicity as the patient. The patient also received blood from a close relative to give her body temporary immune defenses while the transplant lasted.
The researchers presented some of the details of the new case Tuesday at the Conference on Retroviruses and Opportunistic Infections in Denver, Colorado.
The gender and racial background of the new case marks an important step forward in developing a cure for HIV, the researchers said. This is because HIV progresses differently in women than in men. Yet while women account for more than half of the world’s HIV cases, they make up only 11% of the participants in cure trials.
Powerful antiretroviral drugs can control HIV, but a cure is key to ending the decades-long pandemic. Worldwide, almost 38 million people are living with HIV and about 73 percent of them are receiving treatment.
A bone marrow transplant is not a realistic option for most patients. Such transplants are highly invasive and risky, so they are generally offered only to people with cancer who have exhausted all other options.
Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, one of multiple divisions of the National Institutes of Health funding the research network behind the new case study, told NBC News that the accumulation of repeated apparent triumphs in curing HIV “continues to provide hope.”
In the United States, African Americans make up about 40% and Hispanics about 25% of the approximately 1.2 million people with HIV. Whites comprise about 28%.
In the first case of what was ultimately considered a successful cure for HIV, researchers treated American Timothy Ray Brown for acute myeloid leukemia, or AML. He received a stem cell transplant from a donor who had a rare genetic abnormality that gives immune cells targeted by HIV a natural resistance to the virus. The strategy in Brown’s case, first made public in 2008, has apparently cured HIV in two other people. But it has also failed in a number of other cases.
Brown remained virus-free for 12 years, until he died in 2020 of cancer. In 2019, another patient, later identified as Adam Castillejo, was reported to have been cured of HIV, confirming that Brown’s case was not a fluke.
Both men received bone marrow transplants from donors carrying a mutation that blocks HIV. The mutation has been identified in only about 20,000 donors, most of whom are of northern European descent.
In the previous cases, when bone marrow transplants replaced their entire immune systems, both men suffered punitive side effects, including graft-versus-host disease, a condition in which the donor’s cells attack the recipient’s body.
Brown almost died after his transplant. Castillejo’s treatment was less intense, but in the year after his transplant he lost nearly 70 pounds, developed hearing loss and survived multiple infections, according to his doctors.
In contrast, the woman in the latter case left the hospital on day 17 after her transplant and did not develop GVHD. The researchers believe that the combination of the umbilical cord blood and cells from her relative could have spared her many of the brutal side effects of a typical bone marrow transplant.
The woman, whose age and identity were withheld for privacy reasons, was diagnosed with HIV in June 2013. Antiretroviral drugs kept her virus levels low. In March 2017, she was diagnosed with acute myelogenous leukemia.
In August of that year, he received umbilical cord blood from a donor with the mutation that blocks HIV from entering cells. But umbilical cord blood cells can take about six weeks to engraft, so she also received partially matched blood stem cells from a first-degree relative.
His relative’s cells boosted his immune system until the umbilical cord blood cells became dominant, making the transplant much less dangerous, according to the research.
The patient chose to discontinue antiretroviral treatment 37 months after transplant. More than 14 months later, she now shows no signs of HIV in blood tests, and she does not appear to have detectable antibodies against the virus, the researchers note.
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