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HIV-1 remission and possible cure in a woman after haplo-cord blood transplant

Hsu, J;Van Besien, K;Glesby, MJ;Pahwa, S;Coletti, A;Warshaw, MG;Petz, L;Moore, TB;Chen, YH;Pallikkuth, S;Dhummakupt, A;Cortado, R;Golner, A;Bone, F;Baldo, M;Riches, M;Mellors, JW;Tobin, NH;Browning, R;Persaud, D;Bryson, Y;International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) P1107 Team, ;

Previously, two men were cured of HIV-1 through CCR5D32 homozygous (CCR5D32/D32) allogeneic adult stem cell transplant. We report the first remission and possible HIV-1 cure in a mixed-race woman who received a CCR5D32/D32 haplo-cord transplant (cord blood cells combined with haploidentical stem cells from an adult) to treat acute myeloid leukemia (AML). Peripheral blood chimerism was 100% CCR5D32/ D32 cord blood by week 14 post-transplant and persisted through 4.8 years of follow-up. Immune reconstitution was associated with (1) loss of detectable replication-competent HIV-1 reservoirs, (2) loss of HIV-1-specific immune responses, (3) in vitro resistance to X4 and R5 laboratory variants, including pre-transplant autologous latent reservoir isolates, and (4) 18 months of HIV-1 control with aviremia, off antiretroviral therapy, starting at 37 months post-transplant. CCR5D32/D32 haplo-cord transplant achieved remission and a
possible HIV-1 cure for a person of diverse ancestry, living with HIV-1, who required a stem cell transplant for acute leukemia.