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As the International AIDS Conference begins today in Montreal, researchers have just announced the recovery of a patient suffering from blood cancer and HIV. Treated for leukemia, he is the oldest of four people in long-term remission from the AIDS virus after receiving stem cells from a donor with a rare genetic mutation.
Nicknamed “City of Hope” after the California hospital where he was treated, the 66-year-old lived with HIV for more than 31 years, the longest of the three other HIV-positive patients who were declared in remission.
Last February, researchers reported the healing of an American woman, the only woman in this case to date. In addition, AFP reports that another man, a patient from Düsseldorf, is also in remission of the disease. However, to consider him “cured”, doctors wait until they find no trace of HIV during several additional years of follow-up.
As with patients before him, the 60-year-old man achieved stable remission from the virus after undergoing a bone marrow transplant to treat blood cancer. In early 2019, he received a stem cell transplant from an unrelated donor for acute myelogenous leukemia, a form of leukemia that is more common in HIV-positive people later in life. However, the donor presented a homozygous CCR5 delta 32 mutation, a rare genetic mutation that, according to the City of Hope Center, confers resistance to HIV. The virus uses the CCR5 receptor to enter and attack the immune system, but a mutation in the receptor blocks this pathway and prevents HIV from replicating.
A beacon of hope for older HIV-positive people with cancer
In March 2021, the patient stopped taking antiretroviral drugs, which can prevent the formation of new viral particles but not eliminate the viral reservoir, after being vaccinated against COVID-19. Since then, he has been in remission from both HIV and blood cancer, giving hope to older HIV-positive people who also suffer from cancer, according to Dr. Yana Dikter, an infectious disease specialist at the City of Hope.
You should know that before allogeneic transplantation (transplantation of cells from a donor), the patient must undergo at least chemotherapy in order to achieve remission of his cancer. This elderly patient was able to receive a less intensive chemotherapy regimen prior to transplantation, which reduces the risk of transplant-related complications and “may allow older HIV-positive cancer patients to benefit from treatment,” Dicking said.
But it is a complex procedure with potentially serious side effects and is not suitable for most people who are HIV positive. Indeed, “the first thing done in a bone marrow transplant is to temporarily destroy the recipient’s immune system,” Steven Dicks, an HIV specialist at the University of California, explains to AFP. “You would never have done this if you didn’t have cancer.”
The new study, presented at the conference but not yet peer-reviewed, should reveal interesting biological features of HIV-infected cells. “They can breed better than most, they are difficult to kill, they are both resilient and difficult to detect,” said Dix, one of its authors. “That’s why HIV is a lifelong infection.”