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A 67-year-old man living with HIV and leukemia is now free from both the virus and blood cancer after undergoing a successful stem cell transplant from a donor who possessed a very rare genetic mutation. He is only the fourth person worldwide to achieve this fit. While his case and course of treatment are very specific to individuals living with the virus and blood cancers, researchers say it’s an important development in the treatment of the virus. In July, cancer research and treatment center City of Hope presented research at the 2022 International HIV/AIDS Conference that shed some light on the continued push to better understanding and treatment of the virus.
What this means for others living with HIV
The news about the “City of Hope patient” went viral earlier this year of the first person who might have achieved remission from HIV through stem cell transplants.
These stories are important to these individuals but also “serve as a sign of hope in terms of the HIV cure agenda, explained by Dr. Monica Gandhi, MPH, Professor of Medicine and Associate Division Chief (Clinical Operations/ Education) of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF/ San Francisco General Hospital.
“Humans require both the CD4 cell receptor and a co-receptor called CCR5 to take in the virus and become HIV-infected. Those born without a CCR5 receptor — about 10 percent of the population in some places in EuropeTrusted Source, likely evolved due to smallpox protection in the past — cannot be infected with HIV,” Gandhi wrote in an email to Healthline. “This handful of individuals, including this new remission case at the City of Hope medical center, received a stem or bone marrow transplant for leukemia or lymphoma from someone who did not have the CCR5 receptor (after their own immune system wiped [it] out from chemotherapy), making their new cells unable to take in HIV and, thereby, achieving cure.”
Gandhi, who was not affiliated with this research, said it will be interesting to see if, down the line, there are “less invasive ways to work with the CCR5 receptor to achieve ‘cure’” that would not be as dangerous as a stem cell transplant, for example.
Gandhi, Alvarnas, and Dickter all stressed that one needs to contextualize headlines about these cases that casually throw around the word “cure.”
These four cases so far specifically apply to people living with HIV with blood cell cancers and do not apply to the population of people living with HIV at large.
When asked about ramifications of this case, Gandhi said doctors who treat “any patient with a blood cancer and HIV should strive to find a match during the stem cell or bone marrow transplant process of cells from a donor who does not carry the CCR5 receptor on their surface.”
Gandhi said these matches are very difficult to achieve during the donation process. First and foremost, their cancer should be treated “as soon as possible at all costs,” she wrote.
“When a donor match can be achieved with this criteria, the patient living with HIV does have a chance to achieve long-term remission like in this case,” Gandhi added.
When asked if this man’s HIV could return to detectable levels Dickter said that there currently is no evidence of HIV replicating in his system.
“We don’t use the term ‘cure’ lightly. This is because HIV can hide in reservoirs in the body, so the term ‘cure’ implies there is complete eradication of the virus from the body. We can’t find any of it — we looked in places in his blood, looked at tissues in the gastrointestinal tract — as of right now, we can’t find any evidence of replicating HIV despite [him] being off antiretroviral therapy,” Dickter said. “But, before we commit to using the term ‘cure,’ it takes more time and more data. However, what we are seeing now is quite promising.”
“However, this is unlikely given the length of time the patient has had off of antiretroviral therapy without a relapse of HIV and examples from the few other cases we have. But, yes, there is always a possibility and this patient should receive regular HIV viral load testing throughout his life to ensure he stays in remission off of antiretroviral therapy.”
Putting this in context: From the beginning of the HIV crisis to today
To put it very mildly, this man has witnessed — and intimately lived through — immense change when it comes to the state of the HIV crisis and what it means to live with it.
Gandhi wrote that this man “is a model in two ways.”
“First, his case demonstrates the power of antiretroviral therapy, which has kept him alive and living a normal life since he was placed on such therapy. So, that is exemplary that he has done so well for so long on powerful HIV therapies,” she wrote.
“The second model, in this case, is that the patient was able to recover from HIV after suffering from leukemia. This showed the tantalizing power of a potential cure for others in his position and, in the future,” Gandhi added.
For Dickter, the outcome of this case is profound. When he was first diagnosed with HIV in the late 1980s, he actually had AIDS.
“He had seen many of his friends and loved ones get very sick and ultimately die from the disease. He also experienced quite a bit of stigma at the time. And got antiretroviral therapy by the late ’90s and he was doing quite well until he was diagnosed with leukemia. Dickter said, “Fortunately, City of Hope was able to perform this stem cell transplant. Which led him into remission from the acute leukemia and HIV simultaneously.
This man’s story stands as a symbol of hope to other.
“As an infectious disease doctor, I always hope that someday [I can] tell patients there is no remaining evidence of the virus in their system,” she said. “And we were able to do that with this patient who lived with the virus for over three decades.”
