A New Yorker has become the first woman possibly cured of HIV after a stem cell transplant. The so-called ‘Patient of New York’, whose case has been published today in the magazine Cellis the fourth person who has achieved a remission of the virus that causes AIDS after undergoing a stem cell transplant.
The woman He also suffered from a type of leukemia. or cancer in the blood. The other three patients who are considered “cured” by science, all men, also suffered from leukemia that required a bone marrow transplant, a risky intervention that is only indicated in hematological cancers. With medical intervention, the malignant tumor and HIV disappeared in all four people.
But the case of the New York Patient has several peculiarities: unlike her male counterparts —known as patients from Berlin, London and Düsseldrof—, she received a transplant with umbilical cord blood cellsrather than with adult stem cells. It has been virus-free since 2017period that, for other similar cases, is considered reasonable to consider that it can be cured.
Furthermore, the New York Patient is a middle-aged woman who identifies as “racially mixed”. This feature is also scientifically significant as it “increases the chance of curing HIV in people of all racial origins,” according to the team in charge of the research, led by the University of California (UCLA) and Johns Hopkins..
“The HIV epidemic is racially diverseand it’s extremely rare for people of color or mixed race to find a sufficiently matched unrelated adult donor,” explained Yvonne Bryson of UCLA and co-director of the study.
However the use of umbilical cord blood cells “expands opportunities for people of diverse ancestry living with HIV who require a transplant for other conditions to achieve a cure.”
The patients in Berlin, London and Düsseldorf received stem cell transplants from matched adults who carried two copies of the CCR5-delta32 mutation, a natural mutation that confers resistance to HIV by preventing the virus from entering and infecting cells.
Only about 1% of Caucasians are homozygous. for the CCR5-delta32 mutation and is even rarer in other populations, limiting the possibility of transplanting them to patients of color, since stem cell transplants often require a high donor-recipient match.
These conditions made it almost impossible to find an adult donor with the aforementioned mutation and compatible with the patient, for which the team transplanted, in 2017, stem cells carrying CCR5-delta32/32 from stored umbilical cord blood to try to simultaneously cure cancer and HIV. Also, those cells were infused with stem cells from one of the patient’s relatives to increase the chances of success of the procedure.
“With cord blood, you don’t have as many cells and they take a little longer to populate the body after infusion,” but using a mixture of stem cells from a relative and cord blood “gives a boost to blood cells umbilical cord,” Bryson said.
the transplant managed to put both HIV and leukemia into remission, which has lasted for more than four years. Thirty-seven months after the transplant, the patient was able to stop taking antiviral medication against HIV. The doctors who follow her say that she has not contracted HIV for more than 30 months since she stopped her antiviral treatment (at the time the study was written, it had only been 18 months).
“Stem cell transplants with CCR5-delta32/32 cells offer a two-for-one cure for people living with HIV and blood cancers,” said Deborah Persaud of Johns Hopkins University and co-leader of the study, quoted by Cell.
However, due to the invasiveness of the procedure, Stem cell transplants (both with and without the mutation) are only being considered for people who need a transplant for other reasons, not for the isolated cure of HIV, a disease for which medication is available.
The study also highlights the importance of having CCR5-delta32/32 cells in stem cell transplants for patients with HIV, since all the cures, up to now, “have been with this population of mutated cells, and the studies in which that have been transplanted new stem cells without this mutation have failed to cure HIV“, stressed Persaud.