A woman in New York has become the third person to go into remission for HIV following a transplant of HIV-resistant stem cells taken from cord blood.
The woman underwent the procedure in 2017 after being diagnosed with acute myelogenous leukaemia (AML). Researchers reported that HIV has not been detected in the woman's blood since she stopped taking antiretroviral therapy (ART) 14 months ago, other than on a single occasion 14 weeks after stopping the drugs.
The treatment is restricted to patients undergoing treatments such as chemotherapy because it is toxic and can cause health problems or even be fatal. 'We estimate that there are approximately 50 patients per year in the USA who could benefit from this procedure,' said Dr Koen van Besien, one of the doctors involved in the treatment.
In order to perform the transplant, the team at Weill Cornell Medical Center had to identify stem cells that matched the patient and also had a gene that confered HIV resistance. This mutation occurs more frequently in people with European ancestry, and less frequently in others. The woman's mixed-race background made finding a suitable donor more difficult, but a national repository of umbilical cord cells allowed the team to screen a multitude of samples and find a suitable match from an infant donor.
'It would've been very difficult to find a match plus this rare mutation unless we were able to use cord blood cells,' Professor Yvonne Bryson, chief of paediatric infectious diseases at the David Geffen School of Medicine at UCLA and study leader, commented.
Cord stem cells can take up to a month to start producing blood, so the transplant was supplemented by stem cells from an adult family member of the woman. These served the dual purpose of helping her blood to replenish more quickly and allowing for cord cells with a less precise genetic match to the woman.
'The ability to use partially matched umbilical cord blood grafts greatly increases the likelihood of finding suitable donors for such patients.' said Dr Besien.
Although the study gives hope for a broader application of the technique, it is unlikely to be widely available to the millions of patients with HIV because of the treatment's potential toxicity.
Two men have previously gone into remission for HIV with this stem cell transplant since it was developed. Details were published in the New England Journal of Medicine in 2009 of Timothy Ray Brown, first known as the 'Berlin patient' when he remained HIV-free for 20 months after discontinuation of HIV therapy following a similar procedure using cord blood. A Latino male known as the 'London patient' has been in remission for more than 30 months (see BioNews 1039).
The study was reported at the Conference on Retroviruses and Opportunistic Infections (CROI) on 15 February 2022. The woman is taking part in the International Maternal Paediatric Adolescent AIDS Clinical Trials (IMPAACT) Network, an observational study of 25 AIDS patients in the USA undergoing cord cell transplantation, started in 2015.
Sources and References
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Third person apparently cured of HIV using novel stem cell transplant
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Researchers document third known case of HIV remission involving stem cell transplant
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HIV-1 remission with CCR5?32?32 haplo-cord transplant in a US woman: IMPAACT P1107
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IMPAACT P1107 team presents first known case of a woman with HIV remission
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Researchers report third case of HIV remission after stem cell transplant using umbilical cord blood
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First woman to be 'cured' of HIV with stem cell blood cancer treatment, say US scientists
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