‘City of Hope Patient’ Achieves HIV Remission Following Stem Cell Transplant

A California man has been in remission from HIV nearly five years after receiving a blood stem cell transplant of rare, HIV-resistant stem cells to treat acute myelogenous leukemia, the treatment team reported this month in the New England Journal of Medicine.

Paul Edmonds, 68, also known as the “City of Hope” patient, is one of just five patients who received an allogeneic stem cell transplant from donors who exhibited a rare mutation in the CCR5 gene (CCR5- Delta 32 mutation) that protects against HIV infection. Edmonds is the person who had HIV the longest among the five patients; he had tested positive for HIV 31 years prior to his stem cell transplant.

The medical team at City of Hope tailored Edmonds’s treatment to address his age and the duration of his HIV. First, he received a chemotherapy-based, reduced-intensity transplant regimen for treatment of older patients with blood cancers. Edmonds then received reduced-intensity chemotherapy, which makes the transplant more tolerable for older patients and reduces the potential for transplant-related complications.

Edmonds received a transplant Feb. 6, 2019, and is now considered to be cured of leukemia. He stopped taking antiretroviral therapies for HIV nearly three years ago and will be considered cured of HIV after he has stopped taking antiretrovirals while remaining free of detectable virus for five years.

According to the treatment team, Edmonds’s case demonstrates that older adults with blood cancers who receive reduced intensity chemotherapy before a stem cell transplant with HIV-resistant donor stem cells may be cured of both cancer and HIV infection.

“City of Hope’s case demonstrates that it is possible to achieve remission from HIV even at an older age and after living with HIV for many years,” said Jana K. Dickter, MD, a clinical professor in City of Hope’s Division of Infectious Diseases, who led the study. “Furthermore, remission can be achieved with a lower-intensity regimen than the therapy received by the four other patients who went into remission for HIV and cancer. As people with HIV continue to live longer, there will be more opportunities for personalized treatments for their blood cancers.”