New scientific breakthroughs may change HIV treatment for people with aggressive cancers like leukemia. Luis Velasco/Stocksy United
- A woman living with HIV in the United States may be the first female and third person to have been “cured” of HIV through stem cell transplants.
- After receiving the treatments, the woman’s HIV reached a state of remission.
- If her remission continues and she is deemed officially “cured” of HIV, she will be just the third individual to be effectively cured of HIV through stem cell treatments.
- Though experts say this is a breakthrough, it isn’t a sign of a new approach to treating the virus that is applicable or ethical to adopt for the greater population of people living with HIV.
A research team out of UCLA recently made a big announcement in the HIV field: the first case of a woman living with HIV in the United States whose HIV reached a state of remission after receiving cutting-edge stem cell transplants.
If her remission continues and she is deemed officially “cured” of HIV, she will be just the third individual to effectively be cured of HIV through stem cell treatments, according to a press release from UCLA.
To put this all into context, experts say this news pinpoints a very specific circumstance. Isolated examples like this one signify a method for tackling HIV that only applies to people with aggressive cancers like leukemia.
This isn’t a sign of a new approach to treating the virus that is applicable or ethical to adopt for the greater population of people living with HIV.
What it does do, however, is paint a more comprehensive picture of where we are in our 21st-century push to better understand, treat, and hopefully find a cure for HIV, now in the fifth decade of the global HIV epidemic.
The use of umbilical cord blood cells
The researchers behind this announcement presented their oral abstract at CROI 2022, or Conference on Retroviruses and Opportunistic Infections, on Feb. 15.
Through their findings, they revealed that the woman in question — the so-called “New York patient” — received a brand-new combination of specialized stem cell transplants that were administered to treat her acute myeloid leukemia (AML).
She has been in remission for this form of leukemia, which occurs in your bone marrow and blood, for 4 1/2 years, and the researchers said she has shown no evidence of an “HIV rebound” in the 14 months since her antiretroviral treatment regimen for the virus ceased.
The case is significant because she would join just two other people — both men — if her remission persists and she is declared “cured” of HIV.
She also would be the first person living with HIV to achieve remission as a result of receiving umbilical cord blood cells that possess a mutation that is protective against HIV-1, known as CCR5-delta32/32 homozygous, combined alongside adult stem cells from a half-matched — called haploidentical — related donor.
Before this case, the other two individuals who were effectively cured of their HIV through stem cell treatments, both received adult donor cells, one from blood stem cells and the other from bone marrow cells, which possessed this protective mutation. Neither received transplants from umbilical cord blood cells.
This woman’s identity is also significant. Not only is she the first female to achieve this HIV remission status through stem cell transplantations but she is of mixed-race ancestry.
It was hard to find the right donor matches for her, given that the genetic abnormality that enables HIV resistance is mostly found in people who have ancestry from northern Europe. The medical team behind this procedure beat the odds and found the needed HIV-resistant abnormality in the umbilical cord blood of an infant donor.
Dr. Ronald G. Collman, director of the Penn Center for AIDS Research in Philadelphia, Pennsylvania, who was not affiliated with this case, told Healthline that stem cell transplants can be pretty dangerous and “everybody agrees that stem cell transplants for HIV cure is not a way forward unless the person needs it” for a very specific reason.
That being said, the fact that this was shown in a woman — and especially a mixed-race woman — is important given that she is part of “an understudied population.” It’s also important that a greater understanding and assessment of people who share her identities “is included in the cure agenda.”
Collman also explained that the use of umbilical cord blood cells stands out in this case. These are cells that are “potentially, readily available.”
Any person who has a child who wants to donate cord blood cells can do so.
He said the innovative approach of combining the cord blood cells in concert with the adult stem cells was novel and sheds light on the inherent “value of cord blood stem cells” for other procedures moving forward.
Dr. Hyman Scott, MPH, the clinical research medical director at Bridge HIV and an assistant clinical professor of medicine at UCSF, who was also unaffiliated with this procedure, told Healthline that there is a high level of complexity tied to cases like this one.
In the case of this individual and the others who came before her who were also being treated for leukemia, they have to be “tightly” matched with appropriate donors to avoid what is known as graft vs. host disease, a possibly dangerous condition in which the “stem cells attack the body of the person they are going into,” Scott explained.
“So, it’s really difficult to find an adequate match for people, and it is hard for some to find matches in time,” he added. “This case used cord blood, and the haplo-type cord transplant meant she didn’t need to have as close of a match as in other cases using [other types of stem cells].”
Scott echoed Collman in discussing the significance of this woman’s identity.
He stressed that since she is a woman is important. So far, most of the cases for these kinds of stem cell transplants have been for men, and given that this specific mutation is concentrated mainly in people from a specific part of Europe, the fact that it could be carried out — and the rights cell matches found — for a mixed-race woman is significant.
“It reflects a difference in both gender and also racial background, so I think those are two elements that make this case an interesting one,” Scott said. “Still, this is very, very rare and there are millions of people who acquire HIV and are living with HIV, and keep in mind this is one of just three cases of this happening, that are being reported right now.”
An evolutionary step forward
This case isn’t the only one recently to make headlines. Last year, news came out about a woman from Argentina whose body might have potentially rid itself of HIV.
This potential “elite controller” of the virus had shown no signs of active HIV in the 8 years since her initial diagnosis. She was the second reported case of someone achieving a state of so-called potential “natural” remission.
When it comes to HIV cured by way of stem cells, Timothy Ray Brown, known as the “Berlin patient” and the first person reported to be cured of the virus through stem cell transplants, died in 2020 at 54 years old with a return of his leukemia.
There have also been instances where attempts to cure HIV through stem cell transplants have been unsuccessful.
All of this is part of the long, winding road from what is considered the first official report of the start of the HIV epidemic on June 5, 1981, to today — a path littered with successes and failure, fits and starts.
With this latest case, the scientists behind this woman’s treatment publicly cautioned against the very definitive use of the word “cure.” She’s being closely observed, and it is yet to be known if her HIV will continue in permanent remission.
Scott said, given this woman is not his patient and he is not tied to observing her care, it’s hard to discuss the specifics of where her case may or may not go moving forward.
That being said, it could give potential opportunities for this hybrid cord-coupled with-adult stem cell approach in the future for other people with aggressive leukemias, for instance.
But for those living with HIV who read headlines about “a cure” and might feel encouraged, Scott suggested viewing these stories through a realistic lens.
“This strategy wouldn’t work for someone who is living with HIV and doesn’t have this kind of malignancy for which this type of treatment is indicated,” Scott said. “So, let’s be excited about this news and how the science is moving in ways that are showing us new things, new approaches. But, it’s not going to be a strategy that we can use to cure HIV in individuals who don’t have this indication for a [stem cell] transplant.”
Collman said Timothy Ray Brown was an example of someone who was “essentially a functionally cured person for the 10 or 12 years or so that he lived after his stem cell transplant.”
He explained that the difference between the state of remission and being “functionally cured” is “a little bit semantic,” but we are in an era of researchers trying all kinds of innovative strategies to find ways to continue to better tackle this virus.
“I do think it is important to keep in perspective with these events that we are learning something new and that is how science moves forward,” Scott said.
“Of course, we want to do that faster, to have an understanding of what is possible more immediately and under what scenarios might give us insights into ways that we might be able to get to a place where we can have more people go into remission with less risky types of procedures.”
Essentially, that aforementioned winding road toward a cure for HIV might seem slow going, but keep in mind that the road is there and science is on it.
“We might hope that we could find some huge revolutionary approach; we might hope we have evolutionary steps, little baby steps forward from where we are, and both are important,” Collman said. “I would call this an evolutionary step forward, not a revolutionary step forward.”
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