06/09/2022
On February 15, Marshall Glesby, chief of infectious diseases at Weill Cornell Medicine and New York-Presbyterian, made a stunning statement.
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The fourth patient who completely recovered from HIV and stopped taking antiretroviral therapy was a woman from New York.
She had to undergo a hematopoietic stem cell transplant, as the first three patients, known as the Berlin, London and Düsseldorf patients
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As a result of HIV infection, the woman progressed acute myeloid leukemia. Hope for recovery was a transplant of donor stem cells. 🩸Umbilical cord blood was chosen. First of all because the woman belongs to a mixed race, so it was difficult to find an identical bone marrow donor. In addition, the donor cells had to carry a rare HIV-resistant CCR5 mutation, which creates an immune system unfavorable to HIV infection. 🧾It was possible to select the necessary sample of umbilical cord blood thanks to the national registry. The woman also received a small part of bone marrow stem cells from a partially compatible relative. These cells could not take root, but functioned for the first weeks, supporting the umbilical cord blood that formed the new immune system. 💪
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After transplant of stem cells from umbilical cord blood, the woman managed to avoid their rejection (painful graft-versus-host reaction), as opposed to Berlin and London patients who received a transplant of HIV-resistant stem cells from the bone marrow. The woman has been in stable remission from cancer for more than 4.5 years and has stopped taking anti-HIV drugs for more than a year.
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In the world, approximately 38 million people are living with HIV, most of whom are forced to take antiretroviral therapy every day. It would seem that a solution has been found, and possible to cure all patients with umbilical cord blood stem cell transplantation.
But although the results of cell therapy are encouraging, there are several problems with the use of stem cell transplantation as a cure for HIV.
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🔺First, the search for a suitable cord blood sample containing the HIV-resistant CCR5 mutation for each patient.
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🔺The second and more important problem is the stem cell transplantation procedure itself. The chemotherapy required for treatment is extremely dangerous and can cause many serious complications and even death. Given the improved efficacy of antiretroviral therapy in the treatment of HIV infection, intensive chemotherapy that destroys one's own immune system is not justified when trying to cure patients of HIV infection alone.
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But for HIV patients who have faced the need for stem cell transplantation, such therapy is very promising, for example, in the treatment of leukemia
