After Transplant, City of Hope Patient in Long-term Remission From HIV and Leukemia

A 66-year-old man who lived with HIV for more than 30 years has been in remission since 2019, following a stem cell transplant from an unrelated donor to treat a blood cancer, according to clinicians from City of Hope, where the man was treated.

The case offers hope for older patients with HIV and blood cancer that a transplant from a donor with a specific genetic mutation could make remission possible, something that was unthinkable for those who lived in an era when HIV/AIDS was considered a death sentence.

Leaders from City of Hope, of Duarte, California, announced the case in a statement, as researchers presented data on the case to open the 24th International AIDS Conference, taking place in Montreal, Canada.

The patient, who is the fourth person in the world to achieve long-term remission from HIV, is the oldest person to achieve remission; he also lived with the disease much longer than the 2 other patients who achieved remission, known as the Berlin Patient and the London Patient. A third patient, the Brazil Patient, was in remission for more than 15 months before his viral load once again increased in summer 2020.

The City of Hope patient received his diagnosis in 1988, years before the arrival of the antiretroviral treatment (ART) known as the AIDS cocktail was available.

The patient was 63 when he was treated with a transplant for acute myelogenous leukemia (AML). The unrelated donor had a rare genetic mutation, homozygous CCR5 Delta 32, which allows those with it to resist acquiring HIV. In their statement, City of Hope officials explained how the CCR5 mutation blocks the pathway the HIV virus uses to attach to CD4+ cells and attack the immune system.

Before receiving the transplant, the patient received a chemotherapy-based, reduced-intensity transplant regimen created by City of Hope and other transplant programs for older patients, who often cannot tolerate standard regimens. Since the procedure, the patient has not shown any signs of replicating HIV virus, and he stopped taking ART in March 2021; the man waited to stop therapy until he could be vaccinated for COVID-19.

“We were thrilled to let him know that his HIV is in remission and he no longer needs to take antiretroviral therapythat he had been on for over 30 years,” said Jana K. Dickter, MD, associate clinical professor in the Division of Infectious Diseases at City of Hope, who outlined the data at the conference. The patient, she said in the statement, “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.”

The patient did not wish to be identified but said in the statement, “I never thought I would live to see the day that I no longer have HIV.”

Dickter said that the case shows how older patients can benefit from transplant, “if the right donor can be identified.”

“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,” Robert Stone, president and CEO of City of Hope and the Helen and Morgan Chu Chief Executive Officer Distinguished Chair, said in a statement. “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.”

This the second case reported this year, and the third overall following a stem cell transplant, in which a patient with HIV and leukemia achieved remission following a transplant from a donor with the CCR5 Delta 32 mutation. The City of Hope patient required 3 therapies to achieve remission before his transplant, said Ahmed Aribi, MD, assistant professor in the Division of Leukemia.

“This patient had a high risk for relapsing from AML, 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.