Man's `death sentence' in remission
DUARTE » A 66-year-old patient at City of Hope Medical Center is living a moment he never thought he'd see as a prognosis once dimmed by HIV and leukemia gradually turned to optimism.
“When I was diagnosed with HIV in 1988, like many others, I thought it was a death sentence,” the man said Wednesday through a City of Hope statement announcing that his HIV had gone into remission. “I never thought I would live to see the day that I no longer have HIV. City of Hope made that possible, and I am beyond grateful.”
The man has gone into longterm remission from HIV and leukemia after receiving a stem cell transplant from a donor with a rare genetic mutation, the hospital said.
According to Dr. Jana K. Dickter at City of Hope, the patient's numbers actually showed that, by definition, he had developed AIDS upon his original HIV diagnosis in 1988.
The patient, who did not want to be identified, received the transplant in early 2019 and has been in remission for the past 17 months after he stopped taking antiretroviral therapy for HIV in March 2021. He is the fourth person in the world to go into long-term remission for at least a year without the use of ART after such a transplant.
Among the four, he had HIV the longest. His case presents opportunities for older patients with HIV and a blood cancer to achieve remission for both if a donor with this rare genetic mutation can be identified.
Prior to the transplant, the patient went through a chemotherapy-based, reduced-intensity transplant regimen that was developed by City of Hope and other transplant programs for treatment of older patients with blood cancers.
The method makes the transplant more tolerable for older patients and reduces the potential for complications from the procedure.
HIV is the virus that causes AIDS, which first was diagnosed in the U.S. in 1981.
Dickter, associate clinical professor in the Division of Infectious Diseases at City of Hope, presented the data virtually Wednesday at the AIDS 2022 news conference.
“It is a big deal,” she said. “I mean, as an infectious disease doctor, I always wanted to tell patients that they might be free of their HIV. To be able to say that to someone is really amazing.”
City of Hope CEO/President Robert Stone, in a statement, was elated.
“We are proud to have played a part in helping the City of Hope patient reach remission for both HIV and leukemia,” Stone said.
“It is humbling to know that our pioneering science in bone marrow and stem cell transplants, along with our pursuit of the best precision medicine in cancer, has helped transform this patient's life. The entire team at City of Hope is honored to make a difference every day in the lives of people with cancer, diabetes and other life-threatening diseases.”
Dickter explained how this happened — the result of a stem cell transplant from a donor carrying the homozygous CCR5 Delta 32 mutation, she said.
“And people who carry this mutation are resistant to most strains of HIV infection,” she said.
“His experience was unique from the other cases given that at the age of 63 he was the oldest patient to receive a stem cell transplant and then go on to receive dual remission,” Dickter added. “He had lived with HIV the longest of the four patients for over 31 years, and he received the least immunosuppressive regimen prior to transplant compared to the three previous patients.”
She said that this does not work for patients who have HIV but not a blood cancer as well.
“Stem cell transplantation is a very complex procedure with a significant potential side effect, so it's not a suitable treatment option for people who are living with HIV without a blood cancer,” Dickter said. “But for those who are living with HIV and who have developed a blood cancer that would benefit from having this procedure, this treatment may be an option even for people who have been living with HIV for many years and those who are older if we're able to find the right donor.”
As stunning as the man's remission is, it's not a panacea. In fact, the man's case was among the brighter lights of sobering reports from the International AIDS Conference beginning this week in Montreal.
University of Barcelona researchers reported that a woman's own immune system seems to have kept her HIV tamped down to an undetectable level for 15 years. But at the same time, hard-won progress against HIV has stalled, putting millions of lives at risk, according to an alarming report Wednesday on how the COVID-19 pandemic and other global crises are jeopardizing efforts to end AIDS.