Abstract
Severely immunosuppressed AIDS patients with recurrent opportunistic infections (OIs) represent an unmet medical need even in the era of antiretroviral therapy (ART). Here we report the development of a human leukocyte antigen (HLA)-mismatched allogeneic adaptive immune therapy (AAIT) for severely immunosuppressed AIDS patients. Twelve severely immunosuppressed AIDS patients with severe OIs were enrolled in this single-arm study. Qualified donors received subcutaneous recombinant granulocyte-colony-stimulating factor twice daily for 4–5 days to stimulate hematopoiesis. Peripheral blood mononuclear cells were collected from these donors via leukapheresis and transfused into the coupled patients. Clinical, immunological, and virological parameters were monitored during a 12-month follow-up period. We found AAIT combined with ART was safe and well-tolerated at the examined doses and transfusion regimen in all 12 patients. Improvements in clinical symptoms were evident throughout the study period. All patients exhibited a steady increase of peripheral CD4+ T cells from a median 10.5 to 207.5 cells/μl. Rapid increase in peripheral CD8+ T-cell count from a median 416.5 to 1206.5 cells/μl was found in the first 90 days since initiation of AAIT. In addition, their inflammatory cytokine levels and HIV RNA viral load decreased. A short-term microchimerism with donor cells was found. There were no adverse events associated with graft-versus-host disease throughout the study period. Overall, AAIT treatment was safe, and might help severely immunosuppressed AIDS patients to achieve a better immune restoration. A further clinical trial with control is necessary to confirm the efficacy of AAIT medication.
Highlights
Chronic human immunodeficiency virus (HIV)-1 replication leads to progressive loss of CD4+ T cells and immune disorders
We developed a human leukocyte antigen (HLA)-mismatched allogeneic adoptive immune therapy (AAIT) combined with antiretroviral therapy (ART) regimen tailored for severely immunosuppressed acquired immune deficiency syndrome (AIDS) patients with CD4+ T-cell counts
There have been no safe and effective immune intervention that can be used alongside ART to address the unmet medical need for advanced AIDS patients, especially those severely immunosuppressed
Summary
Chronic human immunodeficiency virus (HIV)-1 replication leads to progressive loss of CD4+ T cells and immune disorders. Combined antiretroviral therapy (ART) efficiently suppresses viral replication and promotes an increase in CD4+ T cells, thereby reducing the mortality of AIDS patients, it fails to efficiently resolve the immunological issues.[1] As a result, AIDS patients undergoing ART still suffer from non-AIDSrelated events associated with systemic immune-mediated inflammation,[2] and are often with low CD4+ T-cell count even after 2 years of efficient ART.[3] chronic HIV-1 infection can severely destroy the immune system, leading to extremely low CD4+ T-cell counts
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