AIDS-related complex treated by antiviral drugs and allogeneic bone marrow transplantation following conditioning protocol with busulphan, cyclophosphamide and cyclosporin.
A 26-year-old man with AIDS-related complex (ARC) was treated with high-dose busulphan and cyclophosphamide, followed by allogeneic bone marrow transplantation. For 3 months before transplantation he received a combination of four drugs considered active against human immunodeficiency virus (HIV) to reduce the viral burden: zidovudine, acyloguanosine, fusidic acid and phenylidantoin. Although in reduced doses in coincidence with marrow engraftment, zidovudine therapy was scheduled after transplantation in order to protect donor cells from infection with HIV. Engraftment rapidly occurred and was documented by cytogenetic analyses. The post-transplant course was characterized by severe acute GvHD with irreversible hepatorenal failure. The patient died on day 48 after transplantation. Polymerase chain reaction analyses for detecting HIV DNA showed the persistence of positivity at day +30 and +45 after transplantation. Antibodies to specific HIV proteins evaluated with Western blot testing also persisted at days +21 and +35 after transplantation. Circulating immunocomplexes disappeared on day +31, and an increase in the CD4/CD8 ratio occurred. The short survival of the patient, affected by chronic hepatitis too, does not allow final conclusions about the role of BMT in HIV disease.
Torlontano
G
G
Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Roma, Italy.
Di Bartolomeo
P
P
Di Girolamo
G
G
Angrilli
F
F
Verani
P
P
Maggiorella
M T
MT
Dragani
A
A
Iacone
A
A
Papalinetti
G
G
Olioso
P
P
D000386:AIDS-Related Complex / Q000188:drug therapy / Q000628:therapy*; D000328:Adult; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation; D002066:Busulfan; D003520:Cyclophosphamide; D016572:Cyclosporine; D006086:Graft vs Host Disease; D006521:Hepatitis, Chronic / Q000150:complications; D006801:Humans; D017093:Liver Failure / Q000209:etiology; D008297:Male; D015819:Substance Abuse, Intravenous / Q000150:complications
D016572:Cyclosporine; D003520:Cyclophosphamide; D002066:Busulfan