Bone Marrow Transplant to Fight Cancer and HIV Infection

More than 30 years after the first AIDS cases were described, there is still no cure for HIV infection. Treatment is based on antiretrovirals that maintain viral replication suppressed, but need to be taken indefinitely since they are not able to eradicate the infection. In 2009 a ray of light gave hope to the HIV field, with the first case of HIV cure being reported (Hütter, et al. N Engl J Med. 2009;360:692-8). Timothy Ray Brown, better known as “the Berlin patientâ€?, was an HIV-infected individual diagnosed with acute myeloid lymphoma who underwent a myeloablative bone marrow transplant from a donor harbouring the Δ32 mutation at the CCR5 gene in homozygosis. This rare mutation confers resistance to HIV infection by the disruption of CCR5, the major coreceptor used by HIV to enter host cells. More than six years after the transplant, there are no signs of the virus in the blood or in other tissues, despite extensive sampling and lack of antiretroviral therapy (ART). Several factors may have contributed to HIV cure in this person, which is still matter of discussion, including the myeloablative conditioning performed, graft vs. host disease, or full engraftment of CCR5-negative cells.