PURPOSE OF THE STUDY.
HIV uses CD4+ as its primary receptor and chemokine receptors (CCR5 and CXCR4) as coreceptors. The primary receptor used to transmit HIV between people, including in maternal-child transmission, is CCR5. Approximately 1% of northern Europeans have a homozygous deletion (Δ32) in the CCR5 gene that dramatically increases the resistance to HIV infection in affected people. There has been great speculation as to the “curability” of active HIV infection. The purpose of this study was to describe the apparent cure of a single patient.
The case of a single person who received a stem cell transplant from a donor with “natural” resistance to HIV was reported.
Extensive immunologic, virologic, and genetic tests were performed serially on this person.
The patient received a successful transplant for treatment of relapsed acute myeloid leukemia. Long-term follow-up, 4 years at the time of writing, revealed that the patient's CD4+ T cells recovered efficiently; donor-derived CD4+ T cells repopulated the gut mucosal immune system; in vitro alternative chemokine receptor usage, CXCR4, was not impaired on the new T cells; long-lived HIV target cells of host origin (tissue CD4+ T cells and macrophages) were replaced with donor-derived cells after transplantation; and HIV remains undetectable in peripheral blood and multiple tissue compartments over the 45-month course of observation.
This patient was cured of HIV infection.
The now-famous person often referred to as the “German patient,” although in reality an American living in Berlin, provides proof of concept that HIV infection is a curable disease. Although the identification of a CCR5Δ32/Δ32 donor is impractical for almost all other people with HIV, the experience with the German patient has led to a dramatic increase in the attempt to cure HIV. Multiple approaches have been proposed, and many would be applicable to the “average” HIV-infected person. This is reflected in a recent article entitled “The Emerging Race to Cure HIV Infections” (Science. 2011;332:784–789).
- Copyright © 2011 by the American Academy of Pediatrics