A research team in the United States reported that it may have cured female HIV for the first time. Based on past successes and failures in the field of HIV treatment, these scientists hope to expand the pool of people who can receive similar treatments to dozens of people annually. I used the law.
Their patients set foot in a rare club that included three men whose scientists had, or probably cured, cure HIV. Researchers also know two women whose immune system appears to have defeated the virus very abnormally.
Karl Diffenbach, director of the AIDS division of the National Institute of Allergic Infectious Diseases, one of the several divisions of the National Institute of Health funding the research network behind the new case study, said NBC. “Continue to give hope” in the treatment of HIV, who told the news about the accumulation of repeated obvious wins.
“It’s important to stay successful in line with this policy,” he said.
In The first case of what was ultimately considered a successful HIV treatment, Researchers have treated Timothy Ray Brown in the United States for acute myeloid leukemia, or AML. He received a stem cell transplant from a donor who had a rare genetic abnormality that gave HIV cells immune cells that targeted the natural resistance to the virus. The strategy for Brown, first published in 2008, has since clearly cured the other two HIVs.But it also We’re screwed With other strings.
This treatment process aims to replace an individual’s immune system with another’s immune system, treating cancer while treating HIV. First, doctors must destroy the original immune system with chemotherapy and sometimes irradiation. It is expected that this will destroy as many immune cells as possible that are quietly carrying HIV, despite effective antiretroviral treatment. Second, if the transplanted HIV-resistant stem cells are properly engrafted, new viral copies that may emerge from the remaining infected cells will not be able to infect other immune cells.
Experts say that trying to treat HIV by stem cell transplantation is unethical and has no potentially fatal cancers or other conditions that are already candidates for such dangerous treatments. Attempts to treat humans with toxic and sometimes fatal treatments.
Dr. Deborah Persaud, a pediatric infectious disease specialist at Johns Hopkins University School of Medicine and chair of the Scientific Committee behind a new NIH-sponsored case study (International Maternal Pediatric Adolescent AIDS Clinical Trials Network), said: It is stated in. “I’m very excited about the new cases of potential HIV treatment,” said stem-cell therapy, “it’s not yet a viable strategy for everyone except millions of people living with HIV.”
Pushing the boundaries of HIV treatment science
Dr. Yvonne J. Bryson, a pediatric infectious disease specialist at the University of California, Los Angeles School of Medicine, described a virtually new case study on Tuesday. Conference on retroviruses and opportunistic infections..
A “patient in New York,” who is referred to as a woman because she was treated at the New York Presbyterian Weil Cornell Medical Center in New York City, was diagnosed with HIV in 2013 and leukemia in 2017.
Bryson and Persaw have partnered with a network of other researchers to conduct lab tests to evaluate women. At Weill Cornell, Dr. Jingmei Hsu and Dr. Koenvan Besien, a stem cell transplant program, paired with infectious disease specialist Dr. Marshall Glesby on patient care.
The team has long sought to alleviate the significant challenges researchers face in finding donors whose stem cells can treat a patient’s cancer and treat HIV.
Traditionally, such donors need to be close enough to a human leukocyte antigen, or HLA match, to maximize the chances of a successful stem cell transplant engraftment. Donors must also have rare genetic abnormalities that confer HIV resistance.
This genetic abnormality occurs at a rate of only about 1 percent, primarily among people of northern European ancestry, and even among those who live in the area. Therefore, it is especially unlikely to find a suitable stem cell donor for people who lack substantially similar ancestry.
In the United States, African Americans make up about 40% and Hispanics make up about 25%. 1.2 million people living with HIVWhite accounts for about 28 percent.
Procedures used to treat patients in New York. Hapro code portDeveloped by the Weill Cornell team Expand cancer treatment options For people with hematological malignancies whose HLA lacks the same donor. First, cancer patients receive a cord blood transplant that contains stem cells that correspond to a strong newborn immune system. One day later, they receive a larger transplant of adult stem cells. Adult stem cells proliferate rapidly, but over time they completely replace umbilical cord blood cells.
Compared to adult stem cells, cord blood is more adaptive and generally has fewer exact HLA matches and fewer complications required to successfully treat cancer. However, cord blood usually does not produce enough cells to be effective in treating cancer in adults, so transplantation of such blood has traditionally been limited primarily to pediatric oncology. In haplocode transplantation, additional stem cell transplantation from an adult donor provides a cell excess and helps to compensate for the umbilical cord blood cell deficiency.
“The role of adult donor cells is to speed up the early engraftment process and make transplantation easier and safer,” says van Besien.
For New York patients with mixed race ancestry, the Weill Cornell team and their collaborators discovered a genetic abnormality in HIV resistance in the cord blood of infant donors. They combined transplantation of those cells with stem cells from an adult donor. Both donors had only a partial HLA match with the female, but the combination of the two transplants made this possible.
“In the United States, it is estimated that there are about 50 patients per year who may benefit from this procedure,” van Besien said of the use of haplocode transplantation as an HIV treatment. “The ability to use partially matched cord blood grafts greatly increases the likelihood of finding a suitable donor for such a patient.”
Another advantage of relying on cord blood is that this bank of resources is much easier to screen for a large number of HIV resistance abnormalities than the bone marrow registry where oncologists find stem cell donors. Bryson and her collaborators had already screened thousands of cord blood samples for genetic abnormalities before New York patients were candidates for haplocode treatment.
The female transplant was very successful. She has been in remission from leukemia for over 4 years. Three years after her transplant, she and her clinician discontinued her HIV treatment. After 14 months, she has not yet experienced the resurrection virus.
Multiple ultrasensitive tests cannot detect signs of replicable HIV female immune cells. Also, researchers cannot detect HIV antibodies or immune cells that are programmed to track the virus. They also elicited immune cells from the female and tried to infect them with HIV in a laboratory experiment, but they didn’t help.
“Without the use of umbilical cord blood cells, it was very difficult to find a match and this rare mutation,” Dr. Bryson said at a meeting on Tuesday. “It opens this approach for the greater diversity of the population.”
At this stage, Bryson and her colleagues believe that the woman is in remission.
“You don’t want to call it overkill,” Bryson said at this stage, preferring the word “remission” to “healing.”
Case: Johns Hopkins’ Deborah Perthor was the author of her first case study. Announced in 2013 A picture of a Mississippi child who was in what she called a “functional cure” at the time. After being infected with HIV from the mother apparently in utero, the baby was treated with atypically enhanced antiretroviral therapy shortly after birth. When Persaud published the case study, the infant had not been treated for HIV for 10 months without viral rebound. The news of this supposed HIV treatment has swept the world and ignited media enthusiasm.But the virus in children Rolled up the rebound 27 months after her treatment was interrupted.
If there are no signs of an active virus and sufficient time has passed (several years), the author of this latest case study considers a patient in New York to be cured.
“I’m excited that it worked so well for her,” Bryson said. She said the apparent success of the case gave researchers “more hope and more choice for the future.”
Why is HIV so difficult to treat?
When the highly effective combination antiretroviral treatment for HIV arrived in 1996, Dr. David Ho, one of the designers of this therapeutic revolution and director of the Aaron Diamond AIDS Research Center in New York City, said: Famously theorized With enough time, such drugs can eventually eradicate the virus from the body.
To date, antiretroviral drugs have been started immediately after being infected with HIV, and then treatment has been discontinued. Staying in remission of the virus There have been no rebound viruses for years.
Otherwise, Ho’s prediction proved to be false. Over the past quarter century, HIV treatment researchers have become more and more rigorous about how difficult it is to develop safe, scalable and effective therapies, as well as to treat HIV. I learned.
HIV maintains such a permanent presence in the body because it binds its genetic code to long-lived immune cells and becomes dormant shortly after infection. That is, it will stop producing new virus copies. Because antiretroviral drugs act only on cell replication, HIV can remain in dormant cells for long periods of time, and in some cases even years, under the supervision of such drugs. In the absence of HIV treatment, such cells can restart the engine at any time and cause a large amount of virus to re-grow in the body.
In the case of Timothy Brown Published in 2009Since then, it has ignited the field of HIV treatment research, where financial investment is increasing rapidly.
In 2019, researchers announced two new cases of HIV remission Next treatment That Reflects what Brown received..These are included Lives in London Adam CastillejoA man in Dusseldorf, Germany, suffering from Hodgkin lymphoma and suffering from AML.
More than three years have passed since these two men stopped receiving HIV treatment without viral rebound. As a result, the authors of their respective case studies (Ravindra K. Gupta of the University of Cambridge and Dr. Bjorn Jensen of the University of Dusseldorf Hospital) recently told NBC News that each patient had “almost certainly” cured the virus.
Since 2020, scientists have also published cases of two females. My immune system clearly cures HIV.. They are about 1 in 200 HIV-infected people known as “elite controllers,” and their immune system can significantly suppress viral replication without medication.In their case, their bodies go further Obviously destroyed All functional viruses.
Less toxic treatment
Another major benefit of haplocode transplants received by New York patients is graft-versus-host disease when cord blood is used for reasons that are not fully understood compared to the treatment of three male predecessors. The risk known as is significantly reduced. Host disease. This is a potentially catastrophic inflammatory response in which donor cells fight the recipient’s body. All three other HIV-treated men experienced this, and Brown’s case caused long-term health problems.
Brown died From recurrent leukemia at 54 in September 2020.
The New York patient was the second HIV patient to receive a haplocode transplant in hopes of curing the virus. However, the first person died of cancer shortly after treatment in 2013.
In contrast, patients in New York remain “asymptomatic and healthy,” Bryson said.
“She enjoys her life,” Bryson said.