HIV-1 Remission after Allogeneic Hematopoietic-Cell Transplantation

This correspondence reports a case of long term HIV1 remission in a 63 year old man who underwent allogeneic hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) using donor cells homozygous for the CCR5 Δ32 mutation. The patient had been HIV positive for 31 years and maintained undetectable viral loads under antiretroviral therapy. Following reduced intensity conditioning and HCT, he achieved full donor chimerism and discontinued antiretroviral therapy 25 months post transplant. Over 35 months of follow up, HIV1 RNA and DNA remained undetectable in blood and tissue samples, and his immune cells showed resistance to CCR5 tropic HIV strains. This case adds to the growing evidence that CCR5 Δ32/Δ32 stem cell transplantation can lead to durable HIV remission, even in older patients with reduced intensity conditioning.

This correspondence reports a case of long term HIV1 remission in a 63 year old man who underwent allogeneic hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) using donor cells homozygous for the CCR5 Δ32 mutation. The patient had been HIV positive for 31 years and maintained undetectable viral loads under antiretroviral therapy. Following reduced intensity conditioning and HCT, he achieved full donor chimerism and discontinued antiretroviral therapy 25 months post transplant. Over 35 months of follow up, HIV1 RNA and DNA remained undetectable in blood and tissue samples, and his immune cells showed resistance to CCR5 tropic HIV strains. This case adds to the growing evidence that CCR5 Δ32/Δ32 stem cell transplantation can lead to durable HIV remission, even in older patients with reduced intensity conditioning.