icon-    folder.gif   Conference Reports for NATAP  
  20th International AIDS Conference
July 20-25, 2014
Melbourne, Australia
Back grey_arrow_rt.gif
Allogeneic bone marrow transplantation in two HIV-1 infected patients shows no detectable HIV-1 RNA or DNA, and a profound reduction in HIV-1 antibodies
  ......and absent CD4+ T cell responses to HIV-1 antigen. We also found a profound reduction in HIV-1 Ab detectability in both patients by WB
Reported by Jules Levin
20th International AIDS Conference, 20-25 July, 2014, Melbourne, Australia
Kersten K Koelsch1,2, William Hey-Cunningham1, Sarah C Sasson2, Chester Pearson1, Katherine H Marks2, Yin Xu1, Michelle Bailey1, Bonnie M Hiener3, Sarah Palmer3,4, John Zaunders1, Jeffrey J Post5,6,8, Samuel T Milliken2,7, Anthony D Kelleher1,2, David A Cooper1,2
1The Kirby Institute, UNSW Medicine, UNSW Australia, Sydney, Australia, 2St Vincent's Hospital, Sydney, Darlinghurst, NSW, Australia, 3Westmead Millennium Institute, Westmead, NSW, Australia, 4 University of Sydney, Sydney, NSW, Australia, 5 Prince of Wales Hospital, Randwick, NSW, Australia, 6 The Albion Centre, Surry Hills, NSW, Australia, 7 The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia, 8 Prince of Wales Clinical School, UNSW Medicine, UNSW Australia, Sydney, Australia
IAC: No Detectable HIV RNA or DNA in 2 Bone Marrow Transplant Patients Still on ART - Mark Mascolini - (07/25/14).......Two HIV-positive Australian men who had allogeneic hematopoietic stem-cell transplantation (HSCT) with reduced-intensity conditioning (RIC) for hematologic malignancies and continue antiretroviral therapy (ART) have no HIV RNA or DNA detectable by highly sensitive assays [1]. Fourth-generation chemiluminescence microparticle immunoassay (CMIA) can detect only low levels of HIV antigen and antibody in the two men.


Program Abstract
Allogeneic bone marrow transplantation (BMT) can have significant effects on viral reservoirs in HIV-1 infected individuals, and in one case led to an apparent sterilising cure.
Methods: We studied two HIV-1 infected patients who had undergone allogeneic BMT with reduced intensity conditioning (RIC) for haematologic malignancies. HIV-1 antigens and antibodies (Ag/Ab) were measured by 4th generation chemiluminescence microparticle immunoassay (CMIA) and by Western blot (WB). HIV-1 specific CD4+ T cell responses were measured by CD25/CD134 upregulation. HIV-1 RNA levels in plasma were measured by two separate real-time PCR assays with 20 as well as single copy/ml sensitivity; HIV-1 DNA levels were assessed in peripheral blood mononuclear cells (PBMCs) as well as in isolated CD4+ T cells by PCR using three different primer sets. Both patients were tested for the presence of the CCR5∼32 mutation by PCR.
Results: Two subjects (A and B) received HLA matched, allogeneic stem cell transplants in 2010 (A) and 2011 (B) for non-Hodgkin''s lymphoma and acute myeloid leukaemia respectively. Both patients remained on antiretroviral therapy during and following the procedure. Post-transplant, subject A experienced systemic grade 2 graft versus host disease (GVHD), whereas subject B developed only mild, skin related GVHD. Patient A was heterozygous for the CCR5∼32 mutation post- transplant, patient B was CCR5 wildtype. Following BMT, both patients had no detectable HIV-1 RNA in plasma by either real-time PCR assay, and no detectable HIV-1 DNA by PCR in PBMCs or CD4+ T cells. CD4+ T cell responses to HIV-1 antigen were absent in both patients. Ag/Abs to HIV-1 were detectable by CMIA and WB in both patients prior to BMT. Post-transplant, both patients had low level detectable Ag/Abs on CMIA, but by WB there was only trace antibody detectability in patient A and absent antibodies in patient B.
Conclusions: Assessment of the HIV-1 reservoir size in these two patients after allogeneic BMT with RIC shows undetectable HIV-1 RNA and DNA in peripheral blood and absent CD4+ T cell responses to HIV-1 antigen. We also found a profound reduction in HIV-1 Ab detectability in both patients by WB.