A California man is about to be declared cured of HIV and blood cancer.
Paul Edmonds, 68, who made international headlines last year when he shared his story, still has no signs of either disease five years after a cell transplant that cleared his body of both diseases.
In a new article from the medical team that treated him, doctors said he was officially cured of cancer and that it would be another two years before he was declared cured of HIV – leaving him without medication since 2020.
Mr. Edmonds' medical journey began when he was diagnosed with AIDS in 1988, at a time when the virus was often a death sentence for many gay men.
Despite watching so many of his friends die from the infection, he persevered and lived happily married to his husband until a devastating leukemia diagnosis in 2018 derailed their future plans.
His cancer was being treated with stem cell therapy, in which stem cells damaged by chemotherapy are replaced with healthy stem cells from a donor – when doctors recognized a once-in-a-lifetime opportunity: finding a donor with an HIV-resistant genetic mutation.
Paul Edmonds, 68, (pictured) became the fifth person ever to be cured of HIV after treatment with rare stem cells
In February 2019, Mr. Edmonds received stem cells from his donor
Freddie Mercury (left) had symptoms of HIV/AIDS in 1982, but was not officially diagnosed until 1987. He announced his diagnosis the day before his death in 1991. Rock Hudson (right) was diagnosed with AIDS in 1984 and was one of the first celebrities to disclose his diagnosis the following year. He was also the first major American star to die of AIDS in 1985
Doctors were eager to see if they could repeat the success of previous patients who had been cured of HIV and cancer in this way.
Mr Edmonds is one of only five to have beaten both diseases and the oldest person to do so.
“I'm extremely grateful … I can't thank them enough,” Mr. Edmonds said of his doctors at the City of Hope clinic in California.
Mr. Edmonds, of Desert Hot Springs in Riverside County, received a stem cell transplant, which is the final step in treating blood cancers such as leukemia and lymphoma.
It is given when the blood-forming stem cells in a patient's bone marrow have been killed by radiation or chemotherapy.
Stem cells are special human cells with the ability to develop into many different cell types, such as muscle cells or brain cells.
Healthy, blood-forming stem cells from a donor with similar genes are transplanted into the patient so that the patient can begin producing cancer-free blood.
In Mr. Edmonds' case, the donated stem cells also had a rare genetic mutation linked to resistance to HIV-1.
In 1988, at the height of the country's epidemic, he was diagnosed with HIV and AIDS, which he said felt like a death sentence.
“People died within a few years of finding out they tested positive,” he said of his AIDS experience in San Francisco in the 1980s. “A dark cloud lay over the city.”
Mr Edmonds had been receiving antiretroviral HIV therapy since 1997, which had suppressed his virus to undetectable levels.
However, the therapy does not completely cure HIV, so the virus was always present in his immune cells in the blood.
This means that if therapy is stopped, the virus begins to multiply and becomes detectable in the blood again.
In 2018 he was diagnosed with leukemia. Older patients with HIV often develop blood cancer due to their weakened immune systems.
Mr. Edmond's cancer – acute myeloid leukemia (AML) – is a type of blood cancer that begins in young white blood cells in the bone marrow.
About 19,500 new cases occur in the United States each year.
Symptoms may include fatigue, fever, frequent infections, easy bruising or bleeding, including nosebleeds or heavy periods, and weight loss.
The exact cause of AML is unclear.
Mr. Edmonds (pictured right) with his husband (left) and a friend around 1998
Mr Edmonds was happily married to his husband (pictured right) until a devastating leukemia diagnosis in 2018 seemed to derail their future plans
Transplant patients must first achieve remission of their cancer, which usually requires intensive chemotherapy to remove the cancer cells.
Administering chemotherapy to patients receiving intravenous antiretroviral therapy, as Mr. Edmonds did, can be difficult because chemotherapy can briefly weaken a patient's immune system.
In November 2018, Mr. Edmonds began chemotherapy. It took him three rounds to achieve remission, which was achieved in mid-January 2019.
The next month, Mr. Edmonds received stem cells from his donor.
The stem cells he was given contained two copies of a rare genetic mutation called CCR5 delta-3, which makes people resistant to HIV.
Only one to two percent of the population have this mutation.
HIV uses the CCR5 receptor to enter and attack the immune system, but the CCR5 mutation prevents the virus from entering this route.
The transplant completely replaced Mr Edmond's bone marrow and blood stem cells with those from the donor.
Since the transplant, he has shown no signs of AML or HIV.
In March 2021, Mr Edmonds stopped taking his HIV medication and had his HIV levels checked once a week to ensure the virus had not returned.
Each time no virus was detected.
Mr Edmonds is one of only five people worldwide to have achieved HIV remission as a result of a stem cell transplant.
“The City of Hope case shows that it is possible to achieve remission from HIV even at older ages and after many years with HIV,” said Dr. Jana Dickter, clinical professor in the Division of Infectious Diseases at City of Hope.
“In addition, remission can be achieved with lower intensity treatment than the therapy received by the four other patients who went into remission for HIV and cancer.”
“As people with HIV live longer, there will be more options for personalized treatments for their blood cancer,” she added.
“For those who would benefit from a stem cell transplant to treat their cancer, the idea that they could simultaneously achieve remission from HIV is astonishing,” said Dr. Thicker.
The case was described in the New England Journal of Medicine.
Dr. Stephen Forman, a professor in the Department of Hematology and Hematopoietic Cell Transplantation, said the hospital “won’t stop there.”
“Our researchers are working, among other research initiatives, to create stem cells that have the genetic mutation that makes them naturally resistant to HIV,” he said.
If left untreated, HIV can progress to AIDS, and without medication people typically survive about three years.
An estimated 36.3 million people have died from AIDS-related illnesses since the epidemic began in 1981.
About 1.2 million Americans have HIV, and although there is currently no cure, medications reduce the amount of the virus in the body by preventing it from replicating, meaning it cannot be transmitted to others and does no harm in the body.
Symptoms include fever and muscle aches, headache, sore throat, night sweats and diarrhea, but some may go without symptoms for a decade or more.
Treatment options have evolved significantly since HIV was first discovered in the early 1980s. The course of treatment ranged from taking several pills per day, which may not have worked well at first, to taking a single daily pill that combines all known therapies into one.
Gene editing experts believe they are close to curing HIV after three patients in the US were injected with genetic material along with an enzyme called CAS9.
Early studies suggest that the enzyme can cut out sections of the virus's DNA that become lodged in human cells, thereby eliminating the virus completely.
The aim of the current study is to prove the safety of the treatment. However, data on its effectiveness are expected next year.