A woman in New York City appears to have been effectively cured of HIV after receiving a transplant of HIV-resistant stem cells and antiretroviral therapy. Known as the New York Patient, she is the third person – and the first woman – to achieve remission of HIV after receiving a stem cell transplant from a donor. While the case could potentially pave the way towards curing more people of HIV, the treatment is risky and extremely tough to scale up. Doctors reported the patient has no detectable traces of HIV in their body over a year after stopping antiretroviral therapy following a transplant of HIV-resistant stem cells, essentially meaning she had achieved remission. The team presented the case at the Conference on Retroviruses and Opportunistic Infections (CROI 2022) on Tuesday. Details of the story were also released in a statement by the University of California, Los Angeles, who were involved in the project. The woman, who was diagnosed with HIV-1 in 2013, was being treated for leukaemia using stem cells from a transplant of cord blood – the blood that remains in the placenta and umbilical cord following the birth of a baby. In this case, the cord blood came from an unrelated newborn, but was genetically matched to the patient and also featured the rare CCR5-delta32/32 mutation that makes cells resistant to HIV infection. The woman also received adult stem cells and was taking antiretroviral drugs, a commonly used treatment for people with HIV that reduces their viral load to undetectable levels, allowing them to live long and healthy lives. She eventually came off the antiretrovirals after receiving the stem cell transplant, but levels of the virus did not bounce back and continued to remain undetectable over 14 months later, appearing to prove she is in remission. As mentioned, she is the third person to be effectively cured of HIV. However, there are a few things that make this case particularly groundbreaking. Along with being a woman, the patient is mixed race, which is significant because the woman’s chances of finding a donor who was both a genetic match and featured the CCR5-delta32/32 mutation were very slim, especially because people of color are underrepresented in donor registries. “The fact that she’s mixed race, and that she’s a woman, that is really important scientifically and really important in terms of the community impact,” Dr Steven Deeks, an AIDS expert at the University of California, San Francisco who was not directly involved in the work, told the New York Times. Furthermore, the latest case is significant as the two previous cases used stem cells obtained from bone marrow and blood stem cells, while cord blood was used for this case. Since donor cord blood is more readily accepted by the body, compared to bone marrow, the team says there is less chance of complications and the transplant being rejected. In theory, this makes the risky treatment needed to achieve HIV remission just a little bit easier, which can make all the difference. “Adult donor grafts provide many cells initially and rapid engraftment, but histocompatibility can be an issue leading to risk of graft-versus-host disease [GVHD]. Umbilical cord blood grafts have a lower cell dose and take longer to engraft, but they can be banked for ready availability, and they pose less risk for GVHD. With the combination, the adult graft provides accelerated engraftment until the cord graft takes over,” Dr Yvonne Bryson, a distinguished professor and specialist in HIV pathogenesis at the David Geffen School of Medicine at UCLA, explained in a statement. Source
