Two more people potentially cured of HIV
Key takeaways:
- Two more people have potentially been cured of HIV after undergoing stem cell transplants.
- Like others, the patients received stem cells from donors with a mutation that makes them resistant to HIV.
Two more people have been potentially cured of HIV after receiving stem cell transplants to treat blood cancer or bone marrow disease, physicians reported Monday.
Like a half-dozen or so other cases that have been reported in the last 15 years, both patients received stem cells from donors with a rare genetic mutation that can make a person naturally resistant to HIV infection by keeping the virus from entering human cells.
Some patients who receive these transplants remain free of detectable HIV without taking ART because their immune systems are replaced by the donor’s HIV-resistant system.
Such patients are said to be in sustained treatment-free remission, but experts have told Healio in the past that they are comfortable calling them cured once they have been in remission a long time, since viral rebound would be expected within weeks or months.
Timothy Ray Brown, the first person ever cured of HIV this way, remained free of the virus for more than a decade before he died in 2020 following a recurrence of leukemia.
Experts have cautioned that stem cell transplantation is costly, risky and not a feasible cure for most patients with HIV.
Last summer, physicians in Germany reported the seventh case of HIV cure following stem cell transplantation in a man who received cells from a donor with only one copy of the mutation, which is called CCR5-delta 32. Most of the other patients have received stem cells from a person with two copies of the mutation — meaning both parents had it.
There have been other unique cases of HIV cure achieved through stem cell transplantation, including a man known as the “Geneva patient” who was cured despite receiving cells from someone who did not have the mutation.
The two newest cases, which were announced during the Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, also diverge from the other cases — in different ways.
‘Profoundly difficult’
Paul Rubinstein, MD, an associate professor of medicine in the division of hematology and oncology at the University of Illinois at Chicago, presented the case of a 67-year-old man who had HIV for 14 years before receiving a stem cell transplant for acute myeloid leukemia from a donor who had the CCR5-delta 32 mutation.
Unlike other patients, the man’s HIV rebounded after doctors paused his ART. Rubinstein said during a press conference at CROI that it was clear the rebound infection was from the patient’s existing HIV reservoir of infected — but not previously active — cells.
“We were not able to find any evidence of virus in the circulating cells in the blood or bone marrow” after the transplant, Rubinstein said. “The question we had was: Could this patient even be cured? If we restart HIV meds again and then stop, would his HIV continue to come back? After all, his reservoir survived the stem cell transplant.”
They tried and were successful. The man went back on HIV treatment for 2 years, then initiated another pause, after which he has remained in remission for 10 months, Rubinstein said.
The man’s case differs from the others because he is the first person to achieve sustained treatment-free HIV remission whose HIV initially returned following a transplant using resistant cells, according to Rubinstein and colleagues.
“The case really demonstrates how profoundly difficult it is to get rid of the reservoir after a stem cell transplant,” Rubinstein said. “It shows how protective these CCR5-delta 32 cells are. And — the most important part — if rebound occurs from the reservoir in this kind of transplant, HIV remission is still possible.”
Cases ‘still a little rare’
Marius Trøseid, MD, PhD, a physician at Oslo University Hospital in Norway, summarized the case of the “Oslo patient,” as he is being called — a 58-year-old man with myelodysplastic syndrome who did not have the CCR5-delta 32 mutation but who received a stem cell transplant from his brother, who did.
According to Trøseid and colleagues, the man has been off ART for 2 1/2 years and free of HIV for 4 years — the first case of treatment-free HIV remission following a stem cell transplant from a sibling.
Trøseid noted that the patient developed graft-versus-host disease (GvHD) after the transplant, a serious condition in which a donor’s immune system reacts severely to healthy cells in the recipient, which he said has also been shown to efficiently reduce viral reservoirs.
Doctors treated the patient’s GvHD with ruxolitinib, a Janus kinase inhibitor that may also reduce viral reservoirs, Trøseid said.
“At this stage, these cases are still a little rare,” Trøseid said at the press conference. “Therefore, every case is important to build the knowledge about how cure can be achieved. So far there has been a lot of focus on the CCR5 mutation, but I think after the Geneva patient last year, there’s now more focus on reducing the reservoir. It’s important now to compare all these cases [and] try to find similarities.”
References:
- Rubinstein P, et al. Abstract 531. Presented at: Conference on Retroviruses and Opportunistic Infections; March 9-12, 2025; San Francisco.
- Trøseid M, et al. Abstract 531. Presented at: Conference on Retroviruses and Opportunistic Infections; March 9-12, 2025; San Francisco.
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