Man is oldest person possibly cured of HIV after stem cell transplant
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A 66-year-old man is the oldest person yet to possibly be cured of HIV after undergoing a stem cell transplant, researchers announced Wednesday.
The man had HIV for more than 31 years when he received a blood stem cell transplant in early 2019 for acute myeloid leukemia (AML) using cells from a donor with a rare genetic mutation that prevents HIV from entering human cells, making people who have it resistant to most strains of the virus.
The man has remained free of replicating HIV since his transplant — including for the last 17 months after stopping treatment for HIV, said Jana K. Dickter, MD, a physician at City of Hope National Medical Center in Duarte, California, where the patient was treated. His leukemia also is in remission.
“This research is particularly important because people with HIV continue to live longer thanks to advances in antiretroviral therapy,” Dickter said during a press conference announcing the findings ahead of the AIDS 2022 meeting in Montreal.
She said the case “opens possibilities for other older persons living with HIV and blood cancer to receive a transplant and achieve remission from both diseases if a donor with this rare genetic mutation can be identified.”
At 63 years old when he underwent the procedure, the “City of Hope patient” — as he is being called — was the oldest person with HIV and leukemia to undergo a transplant and go into remission for both, according to Dickter and colleagues.
He is at least the fourth person to have potentially been cured of HIV after receiving stem cells from someone with the CCR5-delta 32 mutation, and the second such case to be made public this year.
In February, researchers at the Conference on Retroviruses and Opportunistic Infections (CROI) announced that, for the first time, a woman had achieved sustained treatment-free remission this way. The so-called “New York patient” was said to be in remission for more than a year without treatment.
Two other cases were announced in past years at CROI, including the “Berlin patient,” later identified as Timothy Ray Brown, who died in 2020 following a recurrence of AML. Brown remained HIV free for the rest of his life after undergoing a bone marrow transplant in 2007.
A man known as the “London patient” who later identified himself as Adam Castillejo was reported in 2020 to have been in HIV remission for 30 months after undergoing allogeneic hematopoietic stem cell transplantation for Hodgkin’s lymphoma.
Experts have warned that stem cell transplantation is too risky and expensive to be a conventional cure for HIV. What these cases have done, however, is prove that it is possible to cure HIV, a complex virus that can be suppressed to undetectable levels with potent medication but remains notoriously difficult to eliminate, experts have said.
“Although a transplant is not an option for more people with HIV, these cases are still interesting, still inspiring, and help illuminate the search for a cure,” Sharon Lewin, MBBS, PhD, president-elect of the International AIDS Society and director of The Peter Doherty Institute for Infection and Immunity in Melbourne, Australia, said during an earlier press briefing. Lewis was not involved in the case.
Before his transplant, the “City of Hope” patient had sustained an undetectable viral load on ART since the 1990s, according to Dickter and colleagues. He had HIV the longest of any of the four patients who have achieved long-term HIV remission via stem cell transplant.
He also received the least immunosuppressive regimen of any of them before his transplant. The regimen was designed for older and less-fit patients “to make transplantation more tolerable for them,” Dickter said.
“This patient’s outcome and the results of this research are profound,” Dickter said. “Because this patient was older, lived the longest with HIV prior to transplant and received the least immunosuppressive therapy compared to the previous patients who had achieved remission from HIV after stem cell transplantation, we now have evidence that some HIV patients with blood cancers may not need fully intensive immunosuppressive therapy prior to transplant in order to put them into remission.”
The man continued taking an ART regimen of emtricitabine, tenofovir alafenamide and dolutegravir for more than 2 years after his transplant, stopping in March 2021 after he was vaccinated against COVID-19.
References:
Dickter J, et al. Abstract 12508. Presented at: International AIDS Conference; July 27-Aug. 2, 2022; Montreal (hybrid meeting).
Patient achieves HIV and blood cancer remission three decades after HIV diagnosis through stem cell transplant at City of Hope. https://www.cityofhope.org/patient-achieves-hiv-and-blood-cancer-remission-three-decades-after-hiv-diagnosis-through-stem-cell. Published July 27, 2022. Accessed July 27, 2022.
Perspective
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There have now been several cases of long-term HIV control following aggressive treatment of cancer diagnosed after HIV was suppressed by ART. Although the inability to detect HIV in these cases doesn't prove that the infection has been truly cured, the longer these remissions are followed, the more likely a true sterilizing eradication or cure has been affected. Each of these cases is important, and we continue to hope that by studying them as a group, we might discover unifying evidence that enables us to find ways to the same end in larger numbers of cases without the toxicity and risk for mortality associated with cancer therapy and stem cell transplantation. The current case extends these previous reports and again used marrow donation from an individual carrying the delta CCR5-delta 32 mutation, which confers HIV infection resistance. We look forward to longer term follow-up of this case and of others that we hope to see over time. HIV cure remains a tremendous goal of a large and dedicated research community.
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Dickter J, et al. Abstract 12508. Presented at: International AIDS Conference; July 27-Aug. 2, 2022; Montreal (hybrid meeting).
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