Known as the City of Hope patient, he is the fourth patient in the world and the oldest to go into long-term remission of HIV without antiretroviral therapy (ART) for over a year after receiving stem cells from a donor with a rare genetic mutation.
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City of Hope, one of the largest cancer research and treatment organizations in the United States, announced that a 66-year-old man who was diagnosed with HIV in 1988 has been in remission of the virus for over 17 months after stopping antiretroviral therapy (ART) for the disease following a stem cell transplant from an unrelated donor for leukemia, according to research presented today at the AIDS 2022 press conference by Jana K. Dickter, M.D., City of Hope associate clinical professor in the Division of Infectious Diseases.
He received the transplant nearly 3 1/2 years ago at City of Hope.
The man, known as the City of Hope patient, lived with HIV for over 31 years, the longest of any of the three previous patients with HIV who have gone into remission for a blood cancer and HIV. He was 63 years old when he received a transplant, the oldest patient to receive a transplant and go into remission for HIV and leukemia.
The patient received a chemotherapy-based, reduced-intensity transplant regimen prior to his transplant that was developed by City of Hope and other transplant programs for treatment of older patients with blood cancers.
Reduced-intensity chemotherapy makes the transplant more tolerable for older patients and reduces the potential for transplant-related complications from the procedure.
The patient received a blood stem cell transplant at City of Hope in early 2019 for acute myelogenous leukemia from an unrelated donor who has a rare genetic mutation, homozygous CCR5 Delta 32.
That mutation makes people who have it resistant to acquiring HIV. CCR5 is a receptor on CD4+ immune cells, and HIV uses that receptor to enter and attack the immune system. But the CCR5 mutation blocks that pathway, which stops HIV from replicating.
The City of Hope patient has not shown any evidence of having replicating HIV virus since the transplant. He stopped taking ART for HIV in March 2021. He might have been able to stop the therapies sooner but wanted to wait until he was vaccinated against COVID-19.
“We are proud to have played a part in helping the City of Hope patient reach remission for both HIV and leukemia. 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,†said Robert Stone, president and CEO of City of Hope and the Helen and Morgan Chu Chief Executive Officer Distinguished Chair.
“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.â€
“We were thrilled to let him know that his HIV is in remission and he no longer needs to take antiretroviral therapy that he had been on for over 30 years,†Dickter said. “He saw many of his friends die from AIDS in the early days of the disease and faced so much stigma when he was diagnosed with HIV in 1988. But now, he can celebrate this medical milestone.â€
“The City of Hope patient’s case, if the right donor can be identified, may open up the opportunity for more older patients living with HIV and blood cancers to receive a stem cell transplant and go into remission for both diseases,†Dickter added.
“When I was diagnosed with HIV in 1988, like many others, I thought it was a death sentence,†the man, who wishes not to be identified, said. “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.â€
City of Hope is a leader in treating patients with blood cancers, as well as patients with HIV and blood cancers with transplants. City of Hope has one of the nation’s leading transplant programs and is at the forefront of using transplants to treat older adults with blood cancers. The institution has performed nearly 18,000 transplants since 1976.
City of Hope was one of the first centers in the United States to perform effective, curative autologous transplants, which use a person’s own stem cells, for patients with HIV-related lymphoma.
When many centers still treated patients with low-intensity, noncurative treatment approaches, City of Hope challenged that paradigm by demonstrating that autologous transplants could be used to cure patients with HIV-related lymphomas who would otherwise die.
City of Hope further pioneered the use of gene-modified blood stem cell transplants to evaluate the use of stem cells engineered to be resistant to HIV infection.
The institution was also a primary national co-leader in two National Cancer Institute-sponsored trials for autologous as well as allogeneic stem cell transplantation, which use a donor’s stem cells, for patients with HIV and blood cancers.
These trials led to a change to the national standards of care on how best to manage this vulnerable patient population.
Leveraging their expertise in cellular immunotherapy, City of Hope scientists have also developed chimeric antigen receptor (CAR) T cells that can target and kill HIV-infected cells and control HIV in preclinical research.
They are working to start a clinical trial using CAR T cell therapy, which has the potential to provide HIV patients with a lifelong viral suppression without ART.
Under the care of City of Hope hematologist Ahmed Aribi, M.D., assistant professor in the Division of Leukemia, the patient received three different therapies to get him into remission before receiving a transplant. Most patients achieve remission after one therapy. The remission is necessary because a transplant is an intensive procedure that can cause serious complications.
The patient did not experience serious medical issues after transplant.
“This patient had a high risk for relapsing from AML [acute myeloid leukemia], making his remission even more remarkable and highlighting how City of Hope provides excellent care treating complicated cases of AML and other blood cancers,†Aribi said. ■