HIV Rebounds in Two Patients with Undetectable Virus After Allogeneic Stem Cell Transplantation — Physician’s First Watch
HIV Rebounds in Two Patients with Undetectable Virus After Allogeneic Stem Cell Transplantation
By Amy Orciari Herman
Edited by Jaye Elizabeth Hefner, MD
Two patients with sustained HIV remission after undergoing hematopoietic stem cell transplantation experienced viral rebound after stopping antiretroviral therapy (ART), according to a report in the Annals of Internal Medicine.
Researchers describe two patients who, 9 months after stem cell transplantation, no longer had detectable HIV-1 DNA in their blood. ART was stopped roughly 2 years after transplantation in one patient and 4 years afterward in the other. In both patients, HIV-1 rebounded, becoming detectable at 12 and 32 weeks after ART cessation — longer than the 1 to 8 weeks typically seen for virus rebound. Both patients developed apparent acute retroviral syndrome; one developed new resistance to efavirenz. Reinitiation of ART led to symptom resolution and viral control.
The researchers write: "Although allogeneic [hematopoietic stem cell transplantation] may lead to significant, sustained reductions in the HIV-1 reservoir, infected tissue or cell-bound virus persists. Persistence of these small numbers of residual infected cells seems to be sufficient to rekindle HIV-1 replication."