The 24th International AIDS Conference completed a five-day in-person and virtual meeting from Montreal in July. Promising reports in several key areas of treatment, prevention, and in the search for a cure sparked an upbeat mood for conference goers. Despite challenging years with the global COVID epidemic, limited healthcare infrastructure and staffing, the changing political climate, and even the new monkeypox outbreak, there continue to be ongoing issues in HIV such as stigma, the growing number of people aging with HIV, and rollout of new prevention tools to everyone globally who needs them.
Even at number [five], I still feel just as much surprise and awe as I did for the first HIV cure of Timothy Ray Brown. I also recognize that this is now the gold standard treatment for the tiny number of people with HIV and a blood cancer who also have access to a suitable matched donor who is CCR5-negative.
A report about the City of Hope cure trial was presented by Jana Dickter of City of Hope at a press conference in Montreal. In 2018 the “City of Hope patient” received stem cells from donated HIV-resistant cells to treat leukemia. “A 66-year-old Caucasian man who received a stem cell transplant is the [fifth] known person to go into HIV remission. Diagnosed with HIV in 1988, he received chemotherapy and an allogeneic hematopoietic stem cell transplant after developing acute myelogenous leukaemia in 2018. Before that, he had an undetectable HIV-1 viral load on ART for many years.
“He continued HIV treatment for 25 months after the stem cell transplant, and his viral load levels remained undetectable 12 months post-analytic treatment interruption. As of 14 months after stopping treatment and 39 months post-transplantation, there is no evidence of HIV RNA rebound and no detectable HIV DNA.
“Immunological studies 37 months after the stem cell transplant and 12 months post-analytic treatment interruption showed a robust response to cytomegalovirus stimulation and no response to HIV CD4 and CD8 T cells.”
I did not know about this trial until my cousin sent me a link to Mark Johnson’s story, “Longtime HIV patient is effectively cured after stem cell transplant,” in the Washington Post on July 27. I realized, however, that my involvement with cure research activism and participation had waned. There were so few successes and the research moved way too slowly for my taste. I didn’t get cured as the second patient to participate in a gene editing trial, even though I believe I got long-term clinical benefit. I realized I would most likely never really get completely cured of HIV and frankly lost interest, until the City of Hope trial.
Paula Cannon, a distinguished professor of molecular microbiology and immunology at the University of Southern California, and one of the most brilliant (and entreating) scientists I have ever known, put it this way, “This is now the [fifth] well-documented case where a hematopoietic stem cell transplantation, given as a necessary treatment for a blood cancer, resulted in a cure of both the cancer and HIV. Even at number [five], I still feel just as much surprise and awe as I did for the first HIV cure of Timothy Ray Brown. I also recognize that this is now the gold standard treatment for the tiny number of people with HIV and a blood cancer who also have access to a suitable matched donor who is CCR5-negative.” Cannon, a British geneticist and virologist, went on to say, “this will always remain a very niche treatment, but the lessons we are learning keep motivating scientists and clinicians as we try to derive parallel approaches that could be used in a much broader group of people. At the same time, advances in cell and gene therapy techniques, which are providing cures for diseases such as sickle cell disease, are also providing new platforms to attempt this. Altogether this makes me very optimistic for continued progress towards a broadly applicable HIV cure.”
This research comes at an important moment when the long-term survivor movement is building confidence, mobilizing, gaining power and hope for a long life. And while a cure using this stem cell approach won’t be for everyone with HIV/AIDS, it provides some relief and hope that there is possibility! Those of us who are the oldest, having gone through 40+ years of the AIDS epidemic, COVID trauma, isolation, suicide, financial and housing insecurity, monkeypox trial and error, despair, loss, and stigma—we can’t give up hope for one small miracle, for a cure in some if not all of us! Some of us survivors might have the chance for a cure.
“This case is exciting because it’s the oldest bone marrow/stem cell transplant to date—proving that chronically infected long-term HIV survivors can successfully undergo this taxing procedure,” said Jeff Taylor, long-term survivor, HIV cure research activist, and community project leader at the HIV & Aging Research Project-Palm Springs. “Given that the majority of PLWH are now over 50—and that proportion will only go up—it’s important that we be conducting cure research in this population.”