Thanks to a bone marrow stem cell transplant performed to treat his leukemia, an HIV-positive patient no longer needs to take drugs against the AIDS virus. The case is reported in the journal Nature Medicine by experts from the University of Dusseldorf: the transplantation of hematopoietic stem cells for the treatment of leukemia induced a persistent suppression of the virus for more than 9 years after the transplant and for 4 years after the suspension of the antiretroviral therapy.
Hiv, patient cured with treatment for leukemia
Matched donor hematopoietic stem cell transplantation (HSCT) is a procedure used to treat certain types of cancer, such as leukemia, by transferring immature blood cells from a donor to repopulate the recipient’s bone marrow. Transplantation involves the transfer of cells from a donor with two copies of the Δ32 mutation in the gene for the HIV co-receptor CCR5; such cells are resistant to HIV infection. So far, there have been two cases of patients experiencing remission from HIV-1 infection after cancer treatment with Δ32-mutated hematopoietic stem cell transplantation: the “London patient” and the “Berlin patient”. The German group is now presenting a detailed analysis of blood and tissue samples from a patient who demonstrated remission of both leukemia and detectable HIV after stem cell transplantation.
The patient
The patient, a 53-year-old man, was diagnosed with acute myeloid leukemia in 2011, for which he received a donor transplant in 2013, followed by chemotherapy. After the transplant, antiretroviral therapy was continued, but HIV was undetectable in the patient’s blood cells. Antiretroviral therapy was suspended in 2018, to determine if the patient’s HIV persisted. The authors did not observe a resurgence of the AIDS virus or an enhancement of the immune response against HIV that could have suggested the presence of a hidden lingering viral reservoir. Although bone marrow transplantation remains a high-risk procedure that is currently only an option for some people with both HIV-1 and hematologic cancers, the authors conclude, these findings may guide future strategies for remission at long term from HIV.