New Yorker first woman to be cured of HIV

An American woman, known as the New York Patient, has become to first woman to be cured of HIV. This is the third known case of a HIV cure, and the first in a woman or person of mixed race. The case study was presented at CROI 2022, the Conference on Retroviruses and Opportunistic Infections.

The Patient

The New York Patient was diagnosed with HIV in 2013 and four years later was diagnosed with acute myeloid leukaemia (AML). At the time of writing the woman has been remission, following treatment, from AML for four and a half years and has had no HIV viral rebound in the 14 months since she stopped HIV antiretroviral therapy (ART).

The treatment

Treatment for the woman’s AML involved total body irradiation, followed by haploidentical bone marrow transplantation which is a type of bone marrow transplant that allows you to transplant half-HLA compatible stem cells.

100 days after rapid engraftment the woman did not experience graft-versus-host disease, as the two earlier patients had, and she “remains clinically well, with no detectable evidence of HIV infection”, said Dr Yvonne Bryson, the protocol chair for the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT), the organization conducting the observational IMPAACT P1107 study.

Rare mutations and umbilical cord cells

The stem cells used for the New York Patient were umbilical cord blood cells with a mutation that is protective against HIV-1 (CCR5-delta32/32 homozygous) combined with stem cells from an adult, haploidentical (“half-matched”) related donor.

That particular, CCR5-delta32 mutation is rare, but the study’s author says that retaining and banking umbilical blood could provide a “previously untapped resource” helping more patients who need bone marrow transplants.

What it means

The study’s authors point out that whilst stem cell transplantation can be an effective way to treat blood or lymph cancers, it is not a therapy for HIV and that it is a very risky procedure - and sometimes fatal.

“This study 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.”

“It also provides proof that HIV-1 viral ‘reservoirs’ can be cleared sufficiently to afford remission and possibly cure in the setting of resistant target cells,” added Dr Bryson.

Cautious optimism

Researchers around the world have greeted the news with cautious optimism, after all there have been cases where the person’s HIV infection has returned after some time. Indeed, this happened to The Brazilian Patient from São Paulo, who maintained an undetectable viral load for 72 weeks - but it eventually rebounded.

Clinicians have been keen to remind the press and public alike that there is currently no viable and safe cure for HIV. Modern antiretroviral therapy is safe and effective at controlling HIV, and people should continue to take their treatment as directed by their clinics.