First, middle-aged women are in remission HIV 14 months after treatment for leukemia by transplantation of adult stem cells and cord blood. If she were to remain untreated without signs of HIV, she would be only the third person in the world. Berlin patient And that Patient in London — Healed by transplantation.
“Her own virus couldn’t infect her cells,” said Yvonne Bryson, director of pediatric infections at the University of California, Los Angeles School of Medicine, David Gefen School of Medicine. (CROI) 2022 Annual Meeting. Both the presenter and the audience participated remotely.
A mixed-race middle-aged New York woman who asked not to share her age with a particular race to protect her privacy was diagnosed with HIV in 2013, when she was still in the early stages of infection. She started treatment immediately and she achieved an undetectable viral load immediately. An undetectable viral load not only prevents someone from infecting others with HIV, but also reduces or eliminates HIV replication. This means less mutations invade cells where the virus can hide and less time.
However, in 2017 she was diagnosed with leukemia. As her last resort to cure her cancer, she received a combination of adult stem cells from the blood of her relatives. This was in close agreement with the cord blood obtained from myself and her cord blood bank. That particular sample of cord blood was selected for its genetic mutation to the CCR5 receptor on immune cells, CD4T cells. The mutation makes the immune system resistant to HIV.
Two previous HIV treatments, Timothy Ray Brown, a patient in Berlin, and Adam Castilejo, a patient in London, also used stem cell transplants with CCR5 mutations, but they were bone marrow transplants. Bone marrow transplants are more difficult than cord blood transplants, which are commonly used in the treatment of childhood cancer.
In this case, the doctor treating her used both.
“This allows adult cells to accelerate and grow until the cord blood takes over,” says Bryson. Bryson pointed out two types of data during his talk at CROI 2022. He first presented data showing the HIV level in the patient’s blood. Immediately after she was diagnosed and treated for HIV, her viral load dropped to undetectable levels. She had a viral spike when she received her transplant, but then it returned undetectable and since then she has remained that way.
Meanwhile, after the transplant, her immune system began to reconstruct itself using the new HIV-resistant cells provided by the transplant. As her care team sees, Graft-versus-host disease (GVH), a common side effect of stem cell transplantation has emerged. In fact, the transplant was so successful that she was discharged early.
100 days after the transplant, the immune system contained in the cord blood was taken over.she CD4 immune cells A little over a year after the transplant, it returned to normal levels. By 27 months, she decided to discontinue all HIV treatment to see if her transplant was successful.
This was a real test. However, Bryson and her colleagues continued to monitor her HIV viral load and CD4 count, searching for her infectious virus and finding nothing. She was HIV negative on antibody tests. Bryson has grown 75 million cells in her lab in search of HIV. none. Researchers never found HIV in patients, except for a momentary drop in detectable HIV DNA in 14 weeks.
“Her cells are now resistant to HIV — both her own and laboratory strains,” Bryson said. Medscape Medical News.. “It’s been 14 months since then. She has no rebounds or detectable viruses.”
The presentation was as noisy as it was praised in a virtual environment. Comments have begun to enter.
“Impressive results,” wrote Jim Hoxy, MD, an emeritus professor at the University of Pennsylvania. “Exciting incidents,” wrote Alison Agu, MD, professor of pediatrics at Johns Hopkins University of Medicine. “Thank you for translating this important treatment strategy into colored races,” wrote Dennis Copertino, a research specialist at Weil Cornell Medicine in New York City.
According to Bryson, most donors with the CCR5 mutation are Caucasian, and this approach has the potential to expand the pool of people living with HIV and cancer, which are potential candidates for this approach in mixed-race females. It suggests.
However, other observers have questions that may require further investigation to be answered. There was also the question of why this female virus after transplantation is immune not only to the CCR5 virus, but also to another variant called CXCR4. Luis Montaner, director of the Immunopathogenicity Institute at the Wistar Institute in Philadelphia, wondered if it was more than blood to remove HIV. Did you get into the tissue? The question has not been answered yet.
The lack of GVH disease was a powerful and hopeful discovery for Dr. Karl Diffenbach, director of the AIDS Division at the National Institute of Health Sciences.
“This says that graft-versus-host disease is needed at some level to get rid of all the last single CD4 + T cells that carry or may not carry a replicative virus. There was a continuous hypothesis, “said Diefenbach. Medscape Medical News.. “But I didn’t have GVH disease. It’s unbelievable. That’s great.”
The current challenge is to make treatment available to others living with HIV from a single case.
The incident also made treatment researchers think.
Montaner calls this case “a promising roadmap to support anti-CCR5 strategies with CRISPR Cas9” and is an ongoing study. Steven Deeks, MD, described the case as “probably a model of how to do this with your own cells, because you never transplanted another person’s cells as a scalable treatment.” ..
For people living with HIV, especially colored women, the consequences raise hope and doubt.Nina Marines knows something about existence “first time”. In 2019, she was the first American woman to live with HIV and donated her kidneys to another person who lives with the virus. For her, her excitement for the first woman to be cured of HIV sheds light on how good white and male HIV treatment studies have been.
“For me, I’m not looking for a cure where a successful step is to get cancer,” she said. Medscape Medical News.. “I’m seeing what’s going to be sustainable. I want to know what works for a group of people.”
Gina Marie Brown, a social worker living with HIV in New Orleans, is also thinking about a group of people.
“Every time we open a breakthrough, it’s like the sun is taken a little more from behind the clouds,” Brown said. “I’m thinking about the people of the South who are heavily burdened with HIV. I’m thinking about transgender women. I’m thinking about black women, gay men, bisexuals, and gay men. It can really affect HIV, just like PrEP [preexposure prophylaxis] Just like you have one tablet once a day. “
When Brown was diagnosed with HIV 22 years ago, she began planning a funeral.
“That’s the amount I thought HIV was a death sentence,” she said. Medscape Medical News.. “Oh, my goodness! I’m glad you got stuck, Gina.”
This study was funded by the National Institutes of Health. Bryson, Dieffenbach, Deeks, and Montaner do not disclose the relevant financial relationships.
Conference on Retroviruses and Opportunistic Infectious Diseases (CROI) 2022 Annual Meeting: Summary 65, announced on February 15, 2022.
Heather Boerner is a science journalist based in Pittsburgh, Pennsylvania. Her book, Positively Negative: Love, Pregnancy, and Science’s Surprising Victory Over HIV, was published in 2014.
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