HIV+ patients and HIV eradication–allogeneic transplantation

G Hütter - Expert Review of Hematology, 2016 - Taylor & Francis
G Hütter
Expert Review of Hematology, 2016Taylor & Francis
Antiretroviral therapy (ART) was the major breakthrough in the management of infection with
human immunodeficiency virus (HIV), leading to a significant benefit in the survival of the
patients. Nevertheless, this treatment is not sufficient to remove the virus from the body, and
viral rebound is commonly observed after discontinuation of antiretroviral medication. Since
the discovery of the HIV as causative for the acquired immune deficiency syndrome (AIDS)
in the 1980s, allogeneic cell therapy, which has shown efficiency in patients with …
Antiretroviral therapy (ART) was the major breakthrough in the management of infection with human immunodeficiency virus (HIV), leading to a significant benefit in the survival of the patients. Nevertheless, this treatment is not sufficient to remove the virus from the body, and viral rebound is commonly observed after discontinuation of antiretroviral medication. Since the discovery of the HIV as causative for the acquired immune deficiency syndrome (AIDS) in the 1980s, allogeneic cell therapy, which has shown efficiency in patients with hematological malignancies, has been considered as a potential treatment option for infected individuals [1]. Patients in the stage of AIDS show a profound lack in peripheral lymphocytes and, especially, in T-helper lymphocytes. In this situation, the life-limiting factors for these patients in the state of AIDS are complications from opportunistic infections due to the deep immune deficiency. From a hematological point of view, it would make sense to substitute immune cells like lymphocyte or granulocyte concentrates from healthy donors. This technique of cell transfer is established and effective in patients with temporary cytopenia together with life-threating infection, eg during cancer chemotherapy treatment. Adoptive T-cell transfer in patients with HIV infection was also sufficient to increase the amount of circulating lymphocytes for a limited period of time but did not last for a longer period and was without remarkable impact on the course of infection [2].
HIV invades predominately bone marrow-derived cells carrying both the CD4 receptor and a suitable chemokine receptor (commonly CCR5). Taking into account that the HIV infection is primary limited to bone marrow-derived target cells, it is not completely fallacious to call HIV a hematological infection. In consequence, effects from stem cell transplantation (SCT) in hematological malignancies could also improve the course of HIV infection. However, this approach is still limited to HIV+ patients with concomitant malignancies. There is some evidence that the maintenance of the infection is mostly limited to T-lymphocytes, and the eligible question in terms of eradication is: does the eradication potency of SCT differ between HIV-infected T-cells and transformed cells in patients with, eg T-cell lymphoma? The latter can effectively be cure by elimination of the malignant cell clone after allogeneic SCT which is a very powerful tool to remove patientLs immune system. After
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