The so-called ‘New York patient’ suffered from leukemia and, unlike the three previous cases, did not require a matched adult donor
A new yorker is the first woman possibly cured of HIV thanks to a stem cell transplant umbilical cord resistant to this virus, which combined with others from a close relative to increase the chances of odds of success.
The so-called ‘New York patient’ He also suffered from a type of leukemia, necessitating a bone marrow transplant, and has been virus-free since 2017, period that, due to other similar cases, is estimated reasonable to consider that it may be cured.
This case was announced a year ago at a medical congress, but until now The results had not been published in any scientific journal. something that the research team, headed by the University of California (UCLA) and Johns Hopkins, does this Thursday in the magazine ‘Cell’.
four people healed
Today four people are considered cured of HIV, patients from Berlin, London, Düsseldorf and now New York. They all also suffered from leukemia that required a bone marrow transplant, a risky intervention that only this indicated in hematological cancers.
The case of the New York patient, a middle-aged woman who identifies as “racially mixed”, has various peculiarities in front of the others: it is the first one that underwent a stem cell transplant resistant to HIV from umbilical cord blood and not of a matched adult donor.
The team considers that the treatment has given “satisfactory long-term results”, indicates the study, and that the use of stem cells from umbilical cord blood increases the chance of curing HIV in people of all racial origins”.
“The HIV epidemic is racially diverse, and it is extremely rare that Black or mixed race people 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 to who are living with HIV and require a transplant for other diseases to be cured.
CCR5-delta32 mutation
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 white people are homozygous for the CCR5-delta32 mutation and is even rarer in other populations, which limits the possibility of transplanting them to patients of color, as 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, so the team transplanted her, in 2017, CCR5-delta32/32-bearing stem cells from umbilical cord blood stored up to try to simultaneously cure cancer and HIV.
In addition, those cells were infused with stem cells from one of the relatives of the patient to increase the chances of success of the procedure.
“With the umbilical cord blood not as many cells are available and they take a little longer to populate body after infusion,” but using a mixture of stem cells from a relative and umbilical cord blood “gives a boost to umbilical cord blood cells,” Bryson pointed out.
“in remission”
The transplant managed to put into remission both HIV and leukemia, which has lasted for more than four years. Thirty-seven months after transplant, the patient was able to stop taking the antiviral medication against HIV. The doctors who monitor her say that have been HIV-free for more than 30 months since stopping antiviral treatment (at the time the study was written, only 18 months had passed).
“Stem cell transplants with CCR5-delta32/32 cells offer a two-for-one cure for people living with the HIV and with blood cancers,” said Deborah Persaud, from Johns Hopkins University and co-director of the study, quoted by ‘Cell’.
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However, due to the invasiveness of the procedure, the stem cell transplants (both with and without the mutation) are only considered for people who need a transplant for other reasons, and not to cure HIV in isolation, a disease for which there is medication.
The study also highlights the importance of having CCR5-delta32/32 cells in stem cell transplants for patients with HIV, since all cures, so far, “have been with this population of mutated cells, and studies transplanting new stem cells without this mutation have failed to cure HIV,” Persaud said.