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

Kersten K Koelsch, Thomas Aagaard Rasmussen, William J. Hey-Nguyen, Chester Pearson, Yin Xu, Michelle Bailey, Katherine H Marks, Sarah C. Sasson, Mark S Taylor, Robyn Tantau, Solange Obeid, Brad Milner, Orla Morrissey, Angie N. Pinto, Kazuo Suzuki, Michael P. Busch, Sheila M. Keating, Philipp Kaiser, Steven Yukl, Joseph K. WongBonnie M Hiener, Sarah E Palmer, John Zaunders, Jeffrey Post, Derek J Chan, Sharon Avery, Sam T Milliken, Anthony D Kelleher, Sharon R. Lewin, David A Cooper

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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.

Original languageEnglish
Pages (from-to)328-337
Number of pages10
JournalJAIDS
Volume75
Issue number3
DOIs
Publication statusPublished - 1 Jul 2017

Keywords

  • HIV
  • immune response
  • reservoirs
  • stem cell transplant
  • stem cells

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