A woman known as the “New York patient” received a stem cell transplant to cure her HIVand now she’s been virus-free and off her HIV medication for about 30 months, researchers report.
“We’re calling this a possible cure rather than a definitive cure — basically waiting for a longer period of follow-up,” Dr. Yvonne Bryson (opens in new tab)director of the Los Angeles-Brazil AIDS Consortium at the University of California, Los Angeles and one of the doctors overseeing the case, said at a press conference on Wednesday (March 15).
Only a handful of people have been cured of HIV, so at the moment there is no official distinction between being cured and being in long-term remission, said Dr. Deborah Persaud (opens in new tab), the interim director of pediatric infectious diseases at Johns Hopkins University School of Medicine, who also oversaw the case. While the New York patient’s prognosis is very good, “I think at this point we’re reluctant to say if she’s cured,” Persaud said at the news conference.
Bryson and her colleagues released early data on the patient in New York in February 2022 and published more details about the case in the magazine on Thursday (March 16). Cell (opens in new tab). The new report covers most of the patient’s case, to the point where she was off antiretroviral therapy (ART) — the standard treatment for HIV — for about 18 months.
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The patient received a stem cell transplant in August 2017 and stopped taking ART just over three years later. Now she is about 2.5 years off the medication and “at the moment she is still doing very well, she is enjoying her life”, Dr Jingmei Hsu (opens in new tab)director of the Cellular Therapy Laboratory at NYU Langone Health and one of the leaders of the transplant team, said at the news conference.
Previous HIV cures – including final cures in men treated in LondonBerlin and Dusseldorf, and one case of prolonged remission in a man being treated in Los Angeles – had received bone marrow stem cell transplants as a dual treatment for both cancer and HIV. (The first patient cured of HIV, a man from Berlin, died in 2020 after a cancer relapse.)
All of these transplants used bone marrow stem cells from adult donors who carried two copies of a rare genetic mutation: CCR5 delta 32. This mutation changes the passageway HIV normally uses to enter white blood cells, thus blocking the entry of the virus. After transplantation, the donor stem cells essentially take over the patient’s immune system and replace their old, HIV-vulnerable cells with new, HIV-resistant cells. To clear the way for the new immune cells, doctors destroy the original immune cell population with chemotherapy or radiation therapy.
Like previous cases, the New York patient had both cancer and HIV and was undergoing chemotherapy prior to her transplant. She did receive stem cells from umbilical cord blood that contain the HIV resistance genes. The cord blood was donated by the parents of an unrelated baby at the time of delivery and later screened for the CCR5 delta 32 mutation.
In addition to those umbilical cord stem cells, because they were relatively few in number, the patient also received stem cells donated by a family member, which helped bridge the gap as her HIV-resistant cells started to come in.
Because cord blood is more easily accessible than adult bone marrow, and easier to ‘match’ between donors and recipients, such procedures could become more common in the future. However, stem cell transplants wouldn’t be appropriate for patients who are HIV-positive but don’t have a second serious illness, such as cancer, because it involves wiping out the immune system, Bryson said.