Annals of internal medicine · 2021
A Possible Sterilizing Cure of HIV-1 Infection Without Stem Cell Transplantation.
Клинический случайСтатьяПоддержка NIH: внешняя программаResearch Support, N.I.H., IntramuralПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Turk Gabriela, Seiger Kyra, Lian Xiaodong, Sun Weiwei, Parsons Elizabeth M, Gao Ce, Rassadkina Yelizaveta, Polo Maria Laura, Czernikier Alejandro, Ghiglione Yanina, Vellicce Alejandra, Varriale Joseph, Lai Jun, Yuki Yuko, Martin Maureen, Rhodes Ajantha, Lewin Sharon R, Walker Bruce D, Carrington Mary, Siliciano Robert, Siliciano Janet, Lichterfeld Mathias, Laufer Natalia, Yu Xu G
Аннотация
BACKGROUND: A sterilizing cure of HIV-1 infection has been reported in 2 persons living with HIV-1 who underwent allogeneic hematopoietic stem cell transplantations from donors who were homozygous for the CCR5Δ32 gene polymorphism. However, this has been considered elusive during natural infection.
OBJECTIVE: To evaluate persistent HIV-1 reservoir cells in an elite controller with undetectable HIV-1 viremia for more than 8 years in the absence of antiretroviral therapy.
DESIGN: Detailed investigation of virologic and immunologic characteristics.
SETTING: Tertiary care centers in Buenos Aires, Argentina, and Boston, Massachusetts.
PATIENT: A patient with HIV-1 infection and durable drug-free suppression of HIV-1 replication.
MEASUREMENTS: Analysis of genome-intact and replication-competent HIV-1 using near-full-length individual proviral sequencing and viral outgrowth assays, respectively; analysis of HIV-1 plasma RNA by ultrasensitive HIV-1 viral load testing.
RESULTS: No genome-intact HIV-1 proviruses were detected in analysis of a total of 1.188 billion peripheral blood mononuclear cells and 503 million mononuclear cells from placental tissues. Seven defective proviruses, some of them derived from clonally expanded cells, were detected. A viral outgrowth assay failed to retrieve replication-competent HIV-1 from 150 million resting CD4+ T cells. No HIV-1 RNA was detected in 4.5 mL of plasma.
LIMITATIONS: Absence of evidence for intact HIV-1 proviruses in large numbers of cells is not evidence of absence of intact HIV-1 proviruses. A sterilizing cure of HIV-1 can never be empirically proved.
CONCLUSION: Genome-intact and replication-competent HIV-1 were not detected in an elite controller despite analysis of massive numbers of cells from blood and tissues, suggesting that this patient may have naturally achieved a sterilizing cure of HIV-1 infection. These observations raise the possibility that a sterilizing cure may be an extremely rare but possible outcome of HIV-1 infection.
PRIMARY FUNDING SOURCE: National Institutes of Health and Bill & Melinda Gates Foundation.
OBJECTIVE: To evaluate persistent HIV-1 reservoir cells in an elite controller with undetectable HIV-1 viremia for more than 8 years in the absence of antiretroviral therapy.
DESIGN: Detailed investigation of virologic and immunologic characteristics.
SETTING: Tertiary care centers in Buenos Aires, Argentina, and Boston, Massachusetts.
PATIENT: A patient with HIV-1 infection and durable drug-free suppression of HIV-1 replication.
MEASUREMENTS: Analysis of genome-intact and replication-competent HIV-1 using near-full-length individual proviral sequencing and viral outgrowth assays, respectively; analysis of HIV-1 plasma RNA by ultrasensitive HIV-1 viral load testing.
RESULTS: No genome-intact HIV-1 proviruses were detected in analysis of a total of 1.188 billion peripheral blood mononuclear cells and 503 million mononuclear cells from placental tissues. Seven defective proviruses, some of them derived from clonally expanded cells, were detected. A viral outgrowth assay failed to retrieve replication-competent HIV-1 from 150 million resting CD4+ T cells. No HIV-1 RNA was detected in 4.5 mL of plasma.
LIMITATIONS: Absence of evidence for intact HIV-1 proviruses in large numbers of cells is not evidence of absence of intact HIV-1 proviruses. A sterilizing cure of HIV-1 can never be empirically proved.
CONCLUSION: Genome-intact and replication-competent HIV-1 were not detected in an elite controller despite analysis of massive numbers of cells from blood and tissues, suggesting that this patient may have naturally achieved a sterilizing cure of HIV-1 infection. These observations raise the possibility that a sterilizing cure may be an extremely rare but possible outcome of HIV-1 infection.
PRIMARY FUNDING SOURCE: National Institutes of Health and Bill & Melinda Gates Foundation.