[ad_1]
Cancer and HIV both rank pretty high on the list of diseases no one wants, and California man Paul Edmonds had both.
But since undergoing certain treatments five years ago, he is both cancer- and HIV-free. This patient is currently considered to be in remission from his acute myeloid leukemia (AML), and since it has been five years since his last treatment, he will be considered “cured” of HIV within another two years. It may be considered.
To celebrate, the medical team that supported his amazing recovery has published a letter describing this case. New England Medical Journal.
The treatment behind remission is known as a stem cell transplant, or in medical parlance, an allogeneic hematopoietic cell transplant.
It is used as a final step in the treatment of blood cancers such as leukemia, myeloma, and lymphoma, where the blood-forming stem cells in a patient’s bone marrow have been destroyed by radiation or chemotherapy. Healthy blood-forming stem cells from a donor with similar (but not identical) genes are transplanted into the patient, where they begin producing cancer-free blood.
In this case, the doctors report that the donated stem cells had the added benefit of a genetic mutation associated with resistance to HIV-1.
Edmonds lived with HIV-1 for 31 years before her transplant.
“People were dying within a few years of testing positive,” Edmonds said, recounting his experience in San Francisco in the 1980s. “Dark clouds have covered the city.”
He was diagnosed with HIV and full-blown AIDS in 1988, telling the National Cancer Institute City of Hope that at the time it felt like a death sentence.
Edmonds has been on HIV antiretroviral therapy since 1997, which effectively suppressed the virus to undetectable levels.
But antiretroviral therapy doesn’t cure HIV, so viral DNA was always present in immune cells in his blood. That is, until his cancer treatment introduced a different type of DNA into his system.
The stem cells Edmonds received in his transplant contained two copies of a rare genetic mutation called CCR5delta-3., people who have this become resistant to HIV. Only about 1 to 2 percent of the population has this mutation, but through City of Hope’s Blood Stem Cell and Bone Marrow Transplant Program, Edmonds’ match was found.
HIV uses the receptor CCR5 to enter and attack the immune system, but mutations in CCR5 prevent the virus from entering through this route.
The transplant completely replaced Edmonds’ bone marrow and blood stem cells with those from the donor, and he has since shown no signs of AML or HIV. He is one of only five people in the world whose HIV has gone into remission with this treatment.
After the transplant, the HIV DNA his blood cells once carried was nowhere to be found. Edmonds agreed to stop her HIV treatment 25 months after the transplant due to scientific considerations, but if the virus was still present, the HIV RNA in her blood could come back.
“At the time of this follow-up, the patient had been free of HIV-1 infection for 35 months after discontinuation of antiretroviral therapy,” the doctors wrote.
“This case showed that elderly patients receiving reduced-intensity conditioning HCT for cancer treatment may be able to cure their HIV-1 infection.”
stem cell transplant involves significant risks, so not everyone living with HIV has access to this treatment. It’s still only viable for people with life-threatening blood cancers and may cure HIV to boot.
Jana Dichter, a City of Hope physician who worked on Edmonds’ case, hopes others will benefit from this two-for-one treatment in the future.
“The idea that people who benefit from stem cell transplantation for cancer treatment could simultaneously experience remission of their HIV infection is surprising,” she says.
This letter was published in New England Medical Journal.
[ad_2]
Source link
