US woman is third person to achieve sustained HIV remission after stem cell transplant
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A middle-aged woman from the United States is the third person — and first woman — to achieve sustained treatment-free HIV remission after undergoing a stem cell transplant, researchers announced Tuesday.
The unnamed woman of mixed race developed high-risk acute myeloid leukemia in 2017 — 4 years after being diagnosed with HIV — and received a haplo-cord stem cell transplant from a donor with a rare genetic mutation called CCR5-delta 32, the researchers reported at the virtual Conference on Retroviruses and Opportunistic Infections (CROI).
She ceased ART for HIV 37 months after receiving the transplant and has remained in HIV remission for 14 months, according to the researchers. Her leukemia is also in remission.
“This provides hope of cord blood cells or haplo cord [cells] to achieve HIV remission for individuals requiring transplantation,” Yvonne J. Bryson, MD, chief of pediatric infectious diseases at the David Geffen School of Medicine at the University of California, Los Angeles, said after presenting the findings at the conference.
The woman joined a short list of people who have potentially been cured of HIV after receiving stem cells from someone with the CCR5-delta 32 mutation, which creates natural resistance by preventing HIV from entering human cells.
“This is a natural mutation, but it’s rare,” occurring in less than 1% of people, Bryson said.
She said donated bone marrow is not routinely screened for the mutation, which is most common among northern Europeans and Caucasians.
The first two people who achieved long-term remission following a similar procedure were initially known as the “Berlin patient” and the “London patient.” Both of their cases were also presented at CROI.
According to NBC News, the woman is being called the “New York patient” because she was treated at New York-Presbyterian Weill Cornell Medical Center. A spokesman for CROI said he believes the name will stick.
The “Berlin patient” was later identified as Timothy Ray Brown, who died in 2020 following a recurrence of leukemia. After undergoing a bone marrow transplant in 2007, Brown remained free of detectable HIV without treatment for more than a decade before his death.
The “London patient” later identified himself as Adam Castillejo and was reported in 2020 to have been in HIV remission for 30 months after undergoing allogeneic hematopoietic stem cell transplantation for Hodgkin’s lymphoma.
Bryson said that the success of a third patient provides additional proof that HIV reservoirs can be cleared sufficiently for remission or cure in the setting of resistant target cells.
Perspective
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There is a limited amount we can learn from a single case that might help us understand any causes responsible for the outcome, but as we have additional cases, we might hope to find underlying conditions that are associated with remission. As we learn more, we might hope to find opportunities to predict this outcome or even design treatments to increase this possibility. Each case, then, is very interesting and potentially important.
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Bryson Y, et al. LB 65. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 12-16, 2022 (virtual meeting).
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