27 July 2022 - - 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 for the disease following a stem cell transplant from an unrelated donor for leukemia, according to research presented at the AIDS 2022 press conference by Jana K. Dickter, M.D., City of Hope associate clinical professor in the Division of Infectious Diseases, California, US-based cancer research and treatment organization City of Hope said.

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.

City of Hope is in treating patients with blood cancers, as well as patients with HIV and blood cancers with transplants.

The institution 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 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.

Founded in 1913, City of Hope has grown into one of the largest cancer research and treatment organizations in the US and one of the leading research centers for diabetes and other life-threatening illnesses.