Madrid. US researchers have presented at the Conference on Retroviruses and Opportunistic Infections (Croi2022) the third known case of HIV remission in a person who received a stem cell transplant. This time, and for the first time, it is about a woman with HIV who received an umbilical cord blood stem cell transplant to treat acute myeloid leukemia.
The woman has had no detectable levels of HIV for 14 months despite stopping antiretroviral therapy (ART), according to researchers from the International Network of Clinical Trials on AIDS in Adolescents and Maternal Pediatrics (Impaact) observational study P1107. led by Yvonne Bryson of the University of California, Los Angeles, and Deborah Persaud of the Johns Hopkins University, Baltimore.
The Impact P1107 study began in 2015 and is an observational study conducted in the US designed to describe the outcomes of up to 25 participants living with HIV who underwent a CCR5A32/A32 umbilical cord blood stem cell transplant for the treatment of HIV. cancer, hematopoietic diseases or other underlying disease.
As a result of the CCR5A32/A32 genetic mutation, the missing cells lack CCR5 co-receptors, which is what HIV uses to infect cells. By killing cancerous immune cells through chemotherapy and then transplanting stem cells with the CCR5 gene mutation, scientists theorize that people with HIV develop an immune system resistant to HIV.
The case described at the Croi2022 meeting involves a woman of mestizo descent who had been on antiretroviral treatment for HIV infection for four years at the time of her diagnosis of acute myeloid leukemia. She achieved remission from acute myeloid leukemia after chemotherapy.
Before receiving the stem cell transplant, the participant’s HIV was well controlled but detectable. In 2017, she received a transplant of CCR5A32/A32 umbilical cord blood stem cells supplemented with adult cells from a relative (called haplocells).
After receiving the stem cell transplant, he engrafted 100 percent cord blood cells on day 100 and had no detectable HIV. At 37 months post-transplant, the patient discontinued ART. According to the study team, HIV was not detected in the participant for 14 months, except for a transient detection of trace amounts of HIV DNA in the woman’s blood cells 14 weeks after stopping ART. Haplo cells were only transiently engrafted and contributed to rapid recovery.
HIV remission resulting from stem cell transplantation had previously been observed in two cases. The first, known as the ‘Berlin patient’ (a Caucasian male), experienced HIV remission for 12 years and considered himself cured of HIV; he died of leukemia in September 2020. And the second was the ‘London patient’ (a Latino man) who has been in HIV remission for over 30 months.
This third case of HIV remission suggests that CCRA5/A32 umbilical cord stem cell transplantation should be considered to achieve HIV remission and cure for people living with HIV who require such a transplant for other conditions, according to the studio team.
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