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HIV Eradication Unlikely Following Bone Marrow Transplantation

many different kinds of studies are ongoing.

French investigators have now reported the first case of a bone marrow transplant in an HIV-positive individual on HAART. The individual, a young man who required a transplant to treat monocytic acute myeloid leukaemia (AML) had achieved an undetectable viral load for 18 months before the transplant, and remained on HAART – with a short interruption – following the transplant until his death 191 days post-transplant.

The investigators used ultra-sensitive methods to measure HIV DNA levels in the man’s peripheral blood mononuclear cells (PBMC). Before transplantation, HIV DNA was at 2.76 log10 copies/106 PBMC. After undergoing bone marrow ablation chemotherapy – which destroyed his own marrow – and then a bone marrow transplant, the procedure was considered a success with full restoration of blood cells after 19 days, and remission from AML confirmed at day 124.

Following the bone marrow transplant, blood plasma HIV RNA remained undetectable and HIV DNA levels examined in more than a million PBMCs became undetectable (<2 log10 copies/106 PBMC), which, write the investigators, “gave hope of a significant reduction of the reservoir, indeed HIV remission.”

However, the man experienced severe graft-versus-host disease (which is when the immune cells from the donated marrow attack the body of the transplant patient, often affecting skin, eyes, stomach and intestines) which was only partially controlled via immunosuppressive drugs.

At 114 days post-transplant, HAART was interrupted for three weeks due to suspected toxicity, and sixteen days after HAART interruption both HIV RNA (4.61 log10 copies/ml) and HIV DNA (2.50 log10 copies/106 PBMC) became detectable again.

Phylogenetic analysis of four plasma viral strains (two in 2003, and two after the transplant) suggested that two totally different HIV quasispecies were in circulation before and after the
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