The Cure of HIV with Hematopoietic Cell Transplantation

Hematopoietic cell transplantation (HCT) has produced the only known cure of HIV infection in a patient. The patient had AML and HIV infection and was transplanted in 2007 using peripheral blood stem cells from an adult CCR5-delta32/delta32 donor. The patient, now known as “The Berlin Patient”, does not require antiretroviral drug therapy and, in the analysis of peripheral blood cells and numerous tissue samples, no proviral DNA can be detected. However, this successful HCT has not been repeated because the frequency of CCR5-delta32/delta32 is less than 1% in Caucasians and much less in other ethnic groups, and patients in need of an HCT generally have only a few potential donors. Moreover, a very close HLA match between donor and patient is required when an adult donor is used. In marked contrast, cord blood HCT requires a significantly less stringent HLA match between donor and patient making it much more feasible to find an appropriate unit for an HIV infected patient. We have tested more than 18,000 cord blood samples from our cord blood bank and collaborating cord blood banks, and have identified 121 cryopreserved CCR5-delta 32/delta32 units that are available for HCT. An adequate cord blood cell dose need be only 1 x 10(7) TNC/kg if a combined haploidentical/cord blood transplant is performed. Projections of HLA match rates for an inventory of 300 homozygous units indicates a probability of finding an adequately matched cord blood unit with an adequate cell dose 82.1% of the time for Caucasian adults and for 85.6% for Caucasian pediatric patients. For adult African-Americans, Mexican-Americans and Chinese-Americans the potential HLA match rates are 31.6%, 48.9% and 13.9%, respectively. Conclusion: Patients who have an indication for an HCT for a hematologic malignancy or other disorder, and who are infected with HIV should be considered for transplantation with a CCR5-delta32/delta32 cord blood unit.