Long-term HIV-1 remission achieved through allogeneic haematopoietic stem cell transplant from a CCR5Δ32/Δ32 sibling donor.
Level 4 - case-series / case-control
Individual clinical case report
PubMed 41975092 · doi:10.1038/s41564-026-02304-8
What was done
Clinical, virological, and immunological characterization of a 63-year-old man with HIV-1 who received an allogeneic haematopoietic stem cell transplant (HSCT) from a CCR5Δ32/Δ32 sibling donor for myelodysplastic syndrome. Peripheral blood, bone marrow, and gut biopsies were analyzed across follow-up to assess chimerism, viral reservoirs, replication-competent virus, HIV-specific T cell responses, and HIV antibodies after antiretroviral therapy (ART) was discontinued.
What was found
ART was discontinued 24 months post-transplant. At 48 months post-HSCT, the patient achieved full donor chimerism across peripheral blood, bone marrow, and gut tissue. No intact HIV DNA was detected in blood or gut biopsies, replication-competent virus was undetectable, HIV-specific T cell responses were absent, and HIV antibody titers showed a gradual decline over a total 5-year follow-up period.
Why it matters
This case adds to the small series of individuals achieving sustained, off-treatment HIV-1 remission following allogeneic transplantation with CCR5Δ32/Δ32 donor cells, demonstrating complete reservoir clearance in both systemic circulation and gut tissue.
Limits
Findings represent a single patient (n=1) undergoing high-risk allogeneic transplantation for a co-occurring hematologic malignancy, an intervention with severe morbidity risks that is not scalable or applicable to the general population living with HIV.
Cited by
- supports Naturally occurring mutations in the CCR5 gene confer resistance to HIV infection.