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On the undesirable roster of illnesses, cancer and HIV are notably high-ranking. One Californian man named Paul Edmonds found himself afflicted with both.

Miraculously, he’s been free of both cancer and HIV ever since one particular treatment five years ago.

Paul is currently deemed to be in remission from acute myelogenous leukaemia (AML). Another two years from now, if all progresses as anticipated, he may become ‘cured’ of HIV, as it will have been five years since his last treatment, per Science Alert.

After navigating HIV for more than 30 years, along with the leukaemia diagnosis that came in 2018, a life-saving stem cell transplant became available thanks to a donor who had a rare genetic mutation that makes the body resistant to most strains of HIV.

The stem cell treatment, known in medical terms as allogeneic hematopoietic cell transplantation, is the final part of treatment for blood cancers like leukaemia, myeloma and lymphoma, where the blood-forming stem cells in a patient’s bone marrow have been destroyed by radiation or chemotherapy.

The patient receives healthy blood-forming stem cells from a donor with similar (though not identical) genetic makeup. These cells are then transplanted into the patient’s body, where they initiate the production of cancer-free blood.

In Paul’s case, the doctors reported that the donated stem cells came with an added benefit: a genetic mutation associated with resistance to HIV-1.

The California man had been living with HIV-1 for 31 years before the transplant, having been diagnosed in 1988 with HIV and full-blown AIDS. At that time, he told the national cancer institute, City of Hope, it felt like a death sentence.

“People were dying within a few years of finding out they were positive,” Edmonds said, describing his experiences in San Francisco in the 80s. “A dark cloud was over the city.”

While Paul had been on HIV antiretroviral therapy since 1997, which had effectively suppressed the virus to undetectable levels, the medication cannot cure the disease as the virus’s DNA remains ever-present in the immune cells in one’s blood.

In a lucky turn of events, Paul was given a stem cell treatment from someone with a really rare HIV-resistant mutation – only about 1-2% of the population have this mutation and Paul found one of these people via the City of Hope’s blood stem cell and bone marrow transplant program.

HIV uses the receptor CCR5 to enter and attack the immune system, but the CCR5 mutation means the virus can’t enter through this pathway.

Because of this treatment, Paul is one of only five people in the world to have ever gone into HIV remission from this treatment.

Edmonds agreed, for science’s sake, to discontinue his HIV treatment 25 months after the transplant, which would have led to a resurgence of HIV RNA in his blood, if the virus was still present.

“At the time of this follow-up, the patient had been free of HIV-1 infection for 35 months after the discontinuation of antiretroviral therapy,” the doctors write.

“This case has shown that older patients who are undergoing reduced-intensity conditioning HCT for the treatment of cancer may be cured of HIV-1 infection.”

Because of the significant risks associated with stem cell transplants, not all individuals living with HIV will qualify for this treatment. It remains a viable option primarily for those facing life-threatening blood cancers, with the potential for HIV cure being a bonus.

[source:sciencealert]