The First Female “Treatment” of HIV with Stem Cell Therapy: What We Know

The researchers behind this announcement presented an oral summary at CROI 2022, or the Conference on Retrovirus and Opportunistic Infections, held on February 15.

Their findings reveal that the woman in question, the so-called “patient in New York,” received a whole new combination of special stem cell transplants given to treat her. Acute myeloid leukemia (AML)..

She has been in remission of this form of leukemia in the bone marrow and blood for four and a half years, and researchers say there was no evidence of “HIV rebound” for 14 months after antiretroviral treatment. increase. The virus treatment was discontinued.

This case is important because if her remission persists and a “cure” of HIV is declared, she will join the other two (both male).

She is also the first person to live with HIV as a result of receiving umbilical cord blood cells with a protective mutation against HIV-1 and is known as the CCR5-delta32 / 32 homozygous. Half match — called a haplotype match — associated donor.

Prior to this case, the other two who were effectively cured of HIV by stem cell therapy both received adult donor cells. One was from blood stem cells and the other was from bone marrow cells. Neither has received a transplant from umbilical cord blood cells.

The identity of this woman is also important. She is not only the first female to achieve this HIV remission by stem cell transplantation, but also a mixed-race ancestor.

Given that the genetic abnormalities that enable HIV resistance are found primarily in people with ancestry from Northern Europe, it was difficult to find a suitable donor match for her. The medical team behind this procedure defeated the odds and discovered the HIV resistance abnormalities required for cord blood in infant donors.

Dr. Ronald G. Colman,director Pen Center for AIDS Research In Philadelphia, Pennsylvania, unrelated to this case, is on the healthline, stem cell transplantation can be quite dangerous, and for very specific reasons, “stem cell transplantation for the treatment of HIV is not a way forward. Everyone agrees with that. ” ..

That said, the fact that this was seen in women, especially mixed-race women, is important given that she is part of a “well-studied population.” It is also important that a deeper understanding and appreciation of those who share her identity is “included in the treatment agenda.”

Colman also explained that the use of umbilical cord blood cells stands out in this case. These are “potentially out-of-the-box” cells.

Anyone with a child who wants to donate umbilical cord blood cells can do so.

He said the innovative approach to combining umbilical cord blood cells in coordination with adult stem cells is novel and sheds light on the unique “value of umbilical cord blood cells” for other procedures to move forward.

Dr. Hyman ScottMPH, director of clinical research and medical care for Bridge HIV and an assistant professor of medicine at UCSF, who is also unrelated to this procedure, told Healthline that such cases have a very complex relationship.

For this individual and others who came before her who was also being treated for leukemia, “closely” match with the appropriate donor to avoid what is known as graft-versus-host disease. is needed. “Stem cells attack the body of the person they are in,” Scott explained.

“So it’s really hard to find the right match for people, and it’s hard to find a match in time,” he added. “We used umbilical cord blood in this case. Haplotype umbilical cord transplants did not require the use of umbilical cord blood as in other cases. [other types of stem cells].. ”

Scott responded to Colman in discussing the importance of this woman’s identity.

He emphasized that she is important because she is a woman. So far, most cases of these types of stem cell transplants are male, and given that this particular mutation is predominantly concentrated in people in certain parts of Europe, it can be done. Facts-and found a right cell match — important for women in mixed races.

“I think these are the two factors that make this case interesting, as it reflects differences in both gender and racial backgrounds,” Scott said. “Still, this is very rare and there are millions of people infected with HIV and living with HIV. Forget that this is one of the three cases currently reported. Please do not. ”

This case is not the only one that has been talked about recently. last year, news It came out about an Argentinean woman whose body could get rid of HIV.

This potential “elite controller” of the virus has shown no signs of active HIV for eight years since her initial diagnosis. She was the second reported case of someone who achieved a so-called “natural” state of remission.

For HIV cured by stem cells, Timothy Ray Brown, known as the “Patient of Berlin,” and the first person to report that the virus was cured by stem cell transplantation, Died in 2020 at the age of 54 With the recurrence of his leukemia.

In some cases, attempts to treat HIV with stem cell transplants have failed.

These are all part of a long, winding road from what was considered the first official report on the onset of the HIV epidemic on June 5, 1981 to today. The path of success and failure begins well.

In this latest incident, the scientists behind the treatment of this woman publicly warned against the very clear use of the word “treatment.” She has been carefully monitored and it is not yet known if her HIV will continue to be in permanent remission.

Scott said it’s hard to discuss in detail where her case goes forward, given that this woman isn’t his patient and isn’t tied to observing her care. ..

That said, it may offer potential opportunities for this hybrid-coded adult stem cell approach in the future, for example, for other people with aggressive leukemia.

But for those who read the headline “Therapies” and live with HIV who may feel encouraged, Scott suggested seeing these stories through a realistic lens.

“This strategy is ineffective for people who live with HIV and do not have this type of malignancy for which this type of treatment is indicated,” Scott said. “Now let’s get excited about this news and how science works in a way that shows new things, new approaches. But it treats HIV in individuals who do not have this indication. Will not be a strategy that can be used for [stem cell] I will transplant it. “

According to Colman, Timothy Ray Brown is an example of a person who “has been essentially functionally healed after a stem cell transplant and has lived for 10 or 12 years.”

He explained that the difference between remission and “functional healing” is “a little semantic”, but we are all sorts of innovative to find ways to continue working on this virus. I am in the age of researchers who are trying out various strategies.

“We think it’s important to keep in mind these events that we are learning something new. That’s how science moves forward,” Scott said.

“Of course, we do it faster, and I have insights into what is possible faster and under what scenarios we can reach a place where more people can be remitted. I want to understand what I might give to us with a less risky type of procedure. ”

In essence, the aforementioned winding road to the treatment of HIV may seem to be on a slow path, but keep in mind that the road is there and the science is there.

“We may expect to find some huge and innovative approaches. We take a step in evolution and a little baby from where we are. You may want it, and both are important, “Colman said. “I call this an evolutionary advance, not a revolutionary advance.”