Woman received cord blood stem cell transplant as a treatment for acute myeloid leukemia. No detectable levels of HIV were found for 14 months after cessation of antiretroviral therapy.
Although there have been two previous known cases of HIV remission involving stem cell transplant in men, researchers have reported the first-ever case of a woman going into remissions went following a transplant.
Yvonne Bryson, M.D., chief of pediatric infectious diseases at the David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital, and Deborah Persaud, M.D., of Johns Hopkins University, led a research team as part of the International Maternal Pediatric Adolescent AIDS Clinical Trial Network (IMPAACT) that studied a woman with HIV who received a cord blood stem cell transplant to treat acute myeloid leukemia.
The results were presented earlier this year at the Conference on Retroviruses and Opportunistic Infections. The study showed that the woman has displayed no detectable levels of HIV for 14 months despite cessation of antiretroviral therapy (ART).
The woman had been on antiretroviral for four years at the time of her acute myeloid leukemia diagnosis and achieved acute myeloid leukemia remission after chemotherapy.
In 2017, the woman received a transplant of CCR5Δ32/Δ32 cord blood stem cells supplemented with adult donor cells from a relative. Once receiving the transplant, she engrafted with 100% cord blood cells at day 100 and had no detectable HIV. By 37 months post-transplant, she ceased ART.
It was pointed out by the researchers that prior to her receiving the stem cell transplant, the woman’s HIV was well controlled but detectable. The study team also noted that there were no traces of HIV in the participant for 14 months, aside for a transient detection of trace levels of HIV DNA in the woman’s blood cells at 14 weeks after stopping ART.
“This study provides hope for the use of cord blood cells or a combination of cord blood cells and haploidentical grafts to achieve HIV-1 remission for individuals requiring transplantation for other diseases,” Bryson said in a statement. “It also provides proof that HIV-1 viral ‘reservoirs’ can be cleared sufficiently to afford remission and possibly cure in the setting of resistant target cells.”
Although the CCR5Δ32/Δ32 mutation is rare, cord blood banks may provide a previously untapped resource, according to the researchers, and the combination therapy would enable clinicians to take advantage of the unique benefits offered by each type of graft for more diverse populations.
The previous two incidents of HIV remission resulting from a stem cell transplant occurred in a Timothy Ray Brown, who was known as the Berlin patient, who was in HIV remission for 12 years and deemed cured of HIV when he died of leukemia in September 2020, and a Latino male who was in HIV remission for more than 30 months.
The third case of HIV remission suggests that CCR5Δ32/Δ32 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 diseases, Bryson said.