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Breakthrough treatment ‘cure’ first woman with HIV

Breakthrough treatment ‘cure’ first woman with HIV


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Cord blood-derived stem cell transplantation was first used to effectively “cure” HIV in women.Layla Burd/Getty Images
  • Researchers have published the full findings of a case study on the first woman to be effectively “cured” of HIV.
  • She is now one of four people who have undergone a stem cell transplant and have gone into remission from HIV.
  • The stem cell transplant for her treatment was the first derived from cord blood.
  • Previous procedures have used stem cell transplants from matched adult donors.

Researchers at the 29th Annual Conference on Retroviruses and Opportunistic Infections announced that in 2022, a fourth patient was effectively “cured.” HIV In this case, stem cell transplantation for blood cancer acute myeloid leukemia (AML)).

Now, a year later, researchers are sharing their full findings in the journal cell.

They paint a picture of the so-called “Patients of New York”. This woman, who identifies as mixed race, is a middle-aged woman who has been living with HIV in remission since 2017.

She follows three other people (all men) who have seen their HIV effectively “cured” as a result of stem cell transplantation.

Their stem cell transplant was from a matched adult donor, while her stem cell transplant was from cord blood.

This case study highlights our growing understanding of how modern medicine is tackling persistent global health crises. World Health Organization (WHO).

Given that this is the first woman of color to achieve HIV remission, do more to include people from underrepresented communities in research, clinical trials, and cutting-edge research It also emphasizes why it is necessary.

Dr. Deborah PelsoCo-first study author, interim chief of pediatric infectious diseases, and professor of pediatrics at the Johns Hopkins University School of Medicine, said this point is particularly important.

“This person is the firstA woman in remission after a stem cell transplant for blood cancer. “Women make up about 50% of people living with HIV worldwide,” Persaud told her Healthline. “Just as her three men gave hope to people living with HIV, so does our case, especially to women.”

Over a decade ago, Timothy Ray Brown, or “Berlin patientwas the first person to be essentially cured of HIV by a stem cell transplant. He died in 2020 after his leukemia returned. This was followed by the ‘London Patient’ Adam Castillejo and the ‘Düsseldorf Patient’, whose identities are unknown.

Last year, announced A 66-year-old man living with HIV and leukemia – a ‘City of Hope patient’ – achieved long-term remission from both diseases as a result of stem cell therapy.

What ties these different cases together is the fact that they all received stem cell transplants for cancer treatment via matched adult donors. I had to have one. The presence of this mutation means that these people do not have the CCR5 receptor required for HIV to enter and infect cells.

About 1% of Caucasians carry this mutation, and it is even rarer in non-Caucasian populations. According to the press releaseAs a result, it is very difficult to find matching stem cell donors for people of color who are being treated for these blood cancers.

To rectify this, researchers used CCR5-delta32/32-bearing stem cells from cord blood to cure her of cancer and eventually HIV. She had her transplant in 2017 at her Weill Cornell Medicine.

“The haplocoding approach with HIV-resistant cord cells is also viable in adults with HIV,” Persaud said, and because the cord cell-matching process is “less rigorous,” the process is “less racially insensitive.” It will be more accessible to diverse populations,” he added.

“What all of these people have in common is that the doctors who are treating them for cancer need to replace their immune systems with new ones because of blood cancers, and they need these new ones to treat two diseases. We were specifically looking for HIV-resistant cells from HIV-resistant cells,” she said.

Persaud emphasized the importance of the fact that he perceives this person to be of mixed race. She says the study shows that being female rather than Caucasian “does not mean that you cannot have a stem cell transplant using HIV-resistant CCR5 homozygous delta32 cord blood cells.” increase.

Dr. Monica Gandhi, MPH, a professor of medicine and associate director (clinical practice/education) of HIV, Infectious Diseases, and Global Health at UCSF/San Francisco General Hospital, says these findings are really a “proof of concept.” says there is. Other cases of stem cell therapy have the dual mandate of treating both blood cancers and HIV at the same time.

“This Cell report showing that this person has had no evidence of HIV in his body for this long is really amazing and very exciting,” said Gandhi, who was not related to the study. increase.

When asked whether this HIV remission would last, Gandhi said it was significant that Timothy Rae Brown had “no evidence of HIV rebound” for more than a decade before he died of a relapse of leukemia. rice field.

He had completely discontinued antiretroviral therapy (ART) during that time.

Other individuals who have gone into remission from HIV have yet to see their HIV return to detectable levels and have also stopped treatment for the virus, she added.

“Adam [Castillejo]They did everything to this poor man, did a rectal biopsy, checked his cerebrospinal fluid for this virus, and found nothing. So he gives these three patients the most hope that HIV will not come back,” Gandhi said. He put it in context that HIV in “New York patients” could return to detectable levels.

Persaud said it has been 27 months since the woman stopped antiretroviral treatment for HIV.

“The longer she doesn’t rebound, the more likely it is that the virus won’t return to detectable viral load levels in her blood in our standard clinical assays,” she said.

The fact that finding matching donors for patients of color is extremely difficult when it comes to searching for these rare genetic mutations for cancer treatments, Persaud said, said the study is an important guideline for the future. said it could be.

“By studying populations as poorly studied as in this case, we have identified a key component of therapeutic success for HIV control: the replacement of the new immune system with HIV-resistant cells, which is It’s something all four participants have in common,” she said. “This also demonstrates racial equality, especially in patient care. [for] We hope that people living with HIV will achieve the amazing results of HIV remission and cure of two major diseases. ”

Gandhi explained that HIV has long been known to be an epidemic that “disproportionately affects people of color” in the United States and throughout the world.

That said, current HIV cure trials are characterized by “underrepresentation of women and underrepresentation of people of color,” Gandhi added.

She said this is a blind spot in medicine and researchPeople of color can do it too. They can, as this latest man to achieve remission of HIV and leukemia proves.

This means that unless these populations remain behind scientific research and take center stage on a par with other observed populations, they will be poorly understood.

“I urge all therapeutic researchers to increase participation in their trials,” she said. There has been some progress, but not enough.”

“There is a growing urgency that we need representation, not just in this country. [but] in order to 38.4 million people worldwide are living with HIVThis is an epidemic disproportionately affecting people in sub-Saharan Africa, for example. Essentially, we don’t want healing initiatives to be available to just a few people or only to white men,” she added.

Clearly, this study applies to a limited subset of people living with HIV. Stem cell transplantation is only applicable to people undergoing cancer treatment and is not reproducible across populations.

Still, the “New York Patient” case offers a glimmer of hope for the future.

“Our understanding is that HIV reservoirs can be sufficiently cleared from individuals by treatment of blood cancers,” Persaud said. “Most of these cases were AML…and control with ART is We can do that by replacing them with HIV-resistant immune cells.”

Persaud added that gene therapy replacement approaches could be the way forward.

“I’m not going to do a bone marrow transplant or an umbilical cord transplant unless it’s necessary for my health, but can I do CRISPR or gene therapy?” Gandhi insisted. “Could we cut out her CCR5 in people living with HIV in a safer way? And that’s what treatment programs are exploring.”

She added that the road to healing has been difficult at best. Phase 3 trial for the HIV vaccine.

“I think this news is really positive, following the failure of vaccine HIV vaccine trials. I didn’t,” said Gandhi. “But this should give us confidence that it is still important to fund more treatments.”

For women of color living with HIV in relatively high numbers, this latest news also offers hope that an underrepresented group in medical research will not be marginalized.

By thinking outside the box and finding stem cell matches for patients who were statistically less likely than their previous male counterparts, the researchers found a solution that could pave the way for further research.

“cure [in this form] It is achievable and remission is achievable by using broader strategies,” Gandhi added. [the ‘New York patient’] give us hope. ”




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