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HIV-1 Remission after Allogeneic Hematopoietic-Cell Transplantation
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Download the PDF here
Download the PDF here
feb 15 2024
see full pdf report attached.
To the Editor:
We report the results of the 60-month follow-up of a 63-year-old man who was found to be free of human immunodeficiency virus type 1 (HIV-1) infection after undergoing hematopoietic-cell transplantation (HCT) for the treatment of acute myelogenous leukemia (AML). The transplant was obtained from a donor with a Δ32 mutation, which causes a CCR5 deletion (CCR5-Δ32/Δ32) that has been associated with resistance to HIV-1 infection. 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 patient had received a diagnosis of HIV-1 infection 31 years before undergoing transplantation, and because of his older age, he had received reduced-intensity conditioning without T-cell depletion, unlike other HCT recipients who have had prolonged HIV-1 control (Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).1-4
The patient, who had a history of undetectable HIV-1 RNA levels since 1997 while receiving antiretroviral therapy, had remission from AML after salvage chemotherapy (Table S2). HCT was recommended for AML cure, and a CCR5-Δ32/Δ32 donor was identified. The patient had wild-type homozygous CCR5 receptors and predominantly R5 virus. After approval by the institutional review board at City of Hope National Medical Center, the patient consented to reservoir testing and eventual interruption of his antiretroviral therapy to assess HIV remission.
At the time of this report, the patient remains in remission from HIV and AML while receiving topical treatment for oral GVHD. His blood, bone marrow, and reservoir sites converted to full chimerism with CCR5-Δ32/Δ32 donor cells. 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.
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