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J Acquir Immune Defic Syndr. 2017 Jul 1;75(3):328-337. doi: 10.1097/QAI.0000000000001381.

Impact of Allogeneic Hematopoietic Stem Cell Transplantation on the HIV Reservoir and Immune Response in 3 HIV-Infected Individuals.

Author information

1
*The Kirby Institute, UNSW Medicine, UNSW Australia, New South Wales, Australia; †St Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia; ‡The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; §The Alfred Hospital, Melbourne, Victoria, Australia; ‖Monash University, Victoria, Australia; ¶Blood Systems Research Institute, San Francisco, CA; #University of California, San Francisco, CA; **Veterans Affairs Medical Centre, San Francisco, CA; ††The Westmead Institute for Medical Research, Westmead, New South Wales, Australia; ‡‡University of Sydney, Sydney, New South Wales, Australia; §§Prince of Wales Hospital, Randwick, New South Wales, Australia; ‖‖The Albion Centre, Surry Hills, New South Wales, Australia; ¶¶Prince of Wales Clinical School, UNSW Medicine, UNSW Australia, New South Wales, Australia; ##School of Public Health, UNSW Medicine, UNSW Australia, New South Wales, Australia; and ***The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.

Abstract

BACKGROUND:

Allogeneic hematopoietic stem cell transplantation (HSCT) can lead to significant changes to the HIV reservoir and HIV immune responses, indicating that further characterization of HIV-infected patients undergoing HSCT is warranted.

METHODS:

We studied 3 patients who underwent HSCT after either reduced intensity conditioning or myeloablative conditioning regimen. We measured HIV antigens and antibodies (Ag/Ab), HIV-specific CD4 T-cell responses, HIV RNA, and DNA in plasma, peripheral blood mononuclear cells, isolated CD4 T cells from peripheral blood, and lymph node cells. The patients remained on antiretroviral therapy throughout the follow-up period.

RESULTS:

All patients have been in continued remission for 4-6 years post-HSCT. Analyses of HIV RNA and DNA levels showed substantial reductions in HIV reservoir-related measurements in all 3 patients, changes in immune response varied with pronounced reductions in 2 patients and a less dramatic reduction in 1 patient. One patient experienced unexpected viral rebound 4 years after HSCT.

CONCLUSIONS:

These 3 cases highlight the substantial changes to the HIV reservoir and the HIV immune response in patients undergoing allogeneic HSCT. The viral rebound observed in 1 patient indicates that replication competent HIV can re-emerge several years after HSCT despite these marked changes.

PMID:
28350553
PMCID:
PMC6097982
DOI:
10.1097/QAI.0000000000001381
[Indexed for MEDLINE]
Free PMC Article

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