HIV Remission Achieved in Patient Who Underwent Specialized Stem Cell Transplant

After 14 months without ART, a patient with HIV only had transient detection of trace levels of HIV DNA in her blood cells after a stem cell transplant for acute myeloid leukemia.

A patient with HIV diagnosed with acute myeloid leukemia (AML) who received a cord blood stem cell transplant was able to achieve HIV remission for 14 months post-transplant, according to an abstract presentation at the Conference on Retroviruses and Opportunistic Infections.

The study authors, from UCLA and Johns Hopkins University, reported these findings as part of the International Maternal Pediatric Adolescent AIDS Clinical Trial Network observational study (IMPAACT P1107) funded by the National Institutes of Health (NIH). The study was initiated in 2015 as an observational analysis of 25 patients with HIV who received a cord blood stem cell transplant for cancer, hematopoietic disease, or another underlying disease.

The female patient was of mixed-race and had been treated for HIV with antiretroviral therapy (ART) for 4 years following her diagnosis in 2013. The study noted that her HIV infection was well-controlled but detectable. In 2017, she underwent the cord blood stem cell transplant to treat her AML, which was supplemented with adult donor cells from a half-matched relative.

By day 100, there was no detectable HIV and at 37 months post-transplant, the patient stopped ART, according to the study.

After 14 months without ART, the patient only had transient detection of trace levels of HIV DNA in her blood cells. The investigators noted that the patient received cells from a relative, which also contributed to rapid recovery.

“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,” study author Yvonne Bryson, chief of pediatric infectious diseases at the David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital, 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.”

The investigators noted that stem cell transplantation is not a therapy for HIV, but its effects on patients with the virus who have blood or lymph cancers may reveal potential targets for treatment. They added that cord blood banks could be an untapped resource that could allow clinicians to reap the benefits of the combination of cord blood stem cell transplants and half-matched or matched relatives’ cells for more diverse patient populations.

“Adult donor grafts provide many cells initially and rapid engraftment, but histocompatibility can be an issue leading to risk of graft-versus-host disease. Umbilical cord blood grafts have a lower cell dose and take longer to engraft, but they can be banked for ready availability, and they pose less risk for [graft-versus-host disease],” Bryson said in the statement. “With the combination, the adult graft provides accelerated engraftment until the cord graft takes over.”

This patient is the third known case of HIV remission following a stem cell transplant, according to the NIH. The first case, known as the Berlin patient, was a Caucasian male whose HIV went into remission for 12 years and was considered cured of the virus prior to his death from leukemia in September 2020.

The second case, known as the London patient, involved a Latino male who has been in HIV remission for more than 30 months. Both the Berlin patient and the London patient used adult donor cells from bone marrow and blood stem cells, whereas the female patient used umbilical cord blood cells.

“This third case of HIV remission suggests that 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, according to the study team,” the NIH said in a statement.

Reference

UCLA Health at CROI: Presenting the case of a woman with HIV-1 in remission following specialized stem cell transplantation for leukemia. UCLA. News release. February 22, 2022. Accessed May 11, 2022. https://www.uclahealth.org/news/ucla-health-croi-presenting-case-woman-with-hiv-1-remission