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

Abstract

<h3>Aims</h3> Two HIV-1 infected patients were studied post-haematopoietic stem cell transplant (HSCT) to determine effects on the viral reservoir. <h3>Methods</h3> HIV-1Ag/Ab was measured by chemiluminescence microparticle immunoassay (CMIA) and western blot (WB). Specific CD4+T-cell responses were measured by CD25/CD134 up-regulation. HIV-1 RNA was measured in serum and HIV-1 DNA was measured in peripheral blood mononuclear cells (PBMCs) and CD4+T-cells by PCR. CCR5 phenotype in PBMC was determined by PCR. <h3>Results</h3> Patient A and B underwent HSCT for non-Hodgkin's lymphoma and acute myeloid leukemia, respectively. Both remained on antiretroviral therapy. Patient A experienced systemic graft-versus-host disease (GVHD), whereas Patient B developed skin GVHD. Patient A was heterozygous for the CCR5Δ32 mutation and Patient B was wild-type. Following HSCT, both patients had undetectable HIV-1 RNA in plasma, and undetectable HIV-1 DNA in PBMCs and CD4+T-cells. Antigen-specific CD4+T-cell responses were absent. Pre-transplant, Ag/Abs to HIV-1 was detectable. Post-transplant, patients had low-level Ag/Abs on CMIA, but trace (Patient A) and absent (Patient B) antibody by WB. <h3>Conclusion</h3> HSCT reduced the HIV-1 reservoir size in these two patients with undetectable HIV-1 RNA in serum and DNA in PBMC/CD4+T-cells and absent antigen-specific CD4+T-cell responses. A profound reduction in Ab to HIV was demonstrated in both patients by WB.