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<p>Woman with acute myeloid leukemia underwent stem cell transplant, which apparently sent the virus into remission.</p>

Third Documented HIV Remission Case Emerges

By Jonathan Springston, Editor, Relias Media

A U.S. patient with HIV who underwent a stem cell transplant to treat acute myeloid leukemia (AML) has recorded no trace of the virus for more than one year, according to details presented this week at the Conference on Retroviruses and Opportunistic Infections.

A woman of mixed race was diagnosed with acute HIV in 2013, and started taking antiretroviral therapy. In 2017, she was diagnosed with AML, and started chemotherapy, which sent the AML into remission. Also in 2017, this patient received cord blood cells that contained the CCR5-delta32/32 mutation, along with adult stem cells from a related donor. As the NIH explained, “by killing off the cancerous immune cells via chemotherapy and then transplanting stem cells with the CCR5 genetic mutation, scientists theorize that people with HIV then develop an HIV-resistant immune system.”

Sure enough, the patient’s body took the cell transplantation well. At day 100, researchers could not find any detectable HIV in this patient. After 37 months, the patient stopped ART; 14 months later, researchers still see no signs of HIV — and her AML remains in remission, too.

Yvonne Bryson, MD, a distinguished professor and specialist in pediatric infectious diseases and HIV pathogenesis at UCLA, is leading the NIH-backed, multicenter, observational IMPAACT P1107, a study she said “provides hope for the use of cord blood cells or a combination of cord blood cells and haploidentical (half-matched) grafts to achieve HIV-1 remission for individuals requiring transplantation for other diseases.”

“Adult donor grafts provide many cells initially and rapid engraftment, but histocompatibility can be an issue, leading to risk of graft-versus-host disease [GVHD]. 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 GVHD,” Bryson added. “With the combination, the adult graft provides accelerated engraftment until the cord graft takes over.”

This is the third known case of stem cell transplantation sending HIV into retreat. The “Berlin patient” was in HIV remission for 12 years before passing away from leukemia in 2020. The “London patient” has been in remission for more than 30 months.

For more on this and related subjects, be sure to read the latest issues of Infectious Disease Alert and Internal Medicine Alert.