Treatment Cures Third Patient Of H.I.V.

Source: New York Times

A woman of mixed race appears to be the third person ever to be cured of H.I.V., using a new transplant method involving umbilical cord blood that opens up the possibility of curing more people of diverse racial backgrounds than was previously possible.

The gender and racial background of the new case mark a significant step forward in developing a cure for H.I.V., the researchers said.. Most donors in registries are of Caucasian origin, so allowing for only a partial match has the potential to cure dozens of Americans who have both H.I.V. and cancer each year, scientists said.

The woman, who also had leukemia, received cord blood to treat her cancer. It came from a partially matched donor, instead of the typical practice of finding a bone marrow donor of similar race and ethnicity to the patient’s. She also received blood from a close relative to give her body temporary immune defenses while the transplant took.

“The fact that she’s mixed race, and that she’s a woman, that is really important scientifically and really important in terms of the community impact,” said Dr. Steven Deeks, an AIDS expert at the University of California, San Francisco.

Infection with H.I.V. is thought to progress differently in women than in men, but while women account for more than half of H.I.V cases in the world, they make up only 11 percent of participants in cure trials.

There have only been two known cases of an H.I.V. cure so far. Referred to as “The Berlin Patient,” Timothy Ray Brown stayed virus-free for 12 years until he dying of cancer in 2020. In 2019, Adam Castillejo was reported to be cured of H.I.V., confirming that Mr. Brown’s case was not a fluke.

The patient was diagnosed with H.I.V. in June 2013. In March 2017, she was diagnosed with acute myelogenous leukemia. In August of that year, she received cord blood from a donor with the mutation that blocks H.I.V.’s entry into cells. But it can take about six weeks for cord blood cells to engraft, so she was also given partially matched blood stem cells from a first-degree relative.

The patient left the hospital by day 17 after her transplant and did not develop graft versus host disease. The combination of cord blood and her relative’s cells might have spared her much of the brutal side effects of a typical bone marrow transplant. The patient opted to discontinue antiretroviral therapy 37 months after the transplant. More than 14 months later, she now shows no signs of H.I.V. in blood tests, and does not seem to have detectable antibodies to the virus.

It’s unclear exactly why stem cells from cord blood seem to work so well. One possibility is that they are more capable of adapting to a new environment. Cord blood may also contain elements beyond the stem cells that aid in the transplant.

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