Allogeneic stem cell transplantation

Abstract

Allogeneic bone marrow transplantation has emerged as an appropriate treatment for patients with HIV infection and standard indications for allogeneic bone marrow transplantation. The early experience before combination antiretroviral therapy and modern supportive measures was disappointing. However, in recent years, many successful transplants have been reported. In one case, HIV cure has been reported (in a patient with an HIV-resistant donor). In other patients maintained on antiretroviral therapy throughout the peritransplant period, substantial decreases in the long-term HIV reservoir have been documented. An interdisciplinary management team and attention to the details of the antiretroviral regimen used are important considerations. Regimens that avoid ritonavir-boosted protease inhibitors will minimize drug-drug interactions. The injectable antiretroviral enfuvirtide can be used to temporarily maintain antiretroviral coverage during periods of mucositis, nausea, or vomiting that may interfere with oral antiretroviral therapy. Symptomatic HIV rebound is a concern for patients whose antiretroviral therapy is interrupted after allogeneic bone marrow transplantation. This may in part reflect the naïveté of the donor immune system with regard to HIV. Therefore, patients whose therapy is interrupted should be monitored especially closely.