Highly active antiretroviral therapy and allogeneic CD34(+) peripheral blood progenitor cells transplantation in an HIV/HCV coinfected patient with acute myeloid leukemia.
OBJECTIVE
To evaluate the safety, feasibility, and efficacy of allogeneic stem cell transplantation (SCT) for acute myelogenous leukemia (AML) in a young female coinfected by HIV and HCV undergoing highly active antiretroviral therapy (HAART).


METHODS
A 33-year-old female HIV(+), HCV(+) in complete remission after standard chemotherapy was submitted to CD34(+) selected allogeneic transplantation from her HLA-identical HIV(-) brother after myeloablative regimen. HAART was started before transplantation, achieving a reduction of HIV load to undetectable levels. GVHD prophylaxis was carried out with cyclosporine A alone.


RESULTS
The patient achieved prompt and durable engraftment with acute GVHD grade II easily managed with steroids; CMV prophylaxis was prolonged, no clinically relevant infectious complications developed early after transplantation and during follow-up. HIV viremia was controlled by HAART although medication adherence was reduced early after transplantation and required drug adjustment. There was a gradual recovery of immune cells with normal CD4-cell count 39 months after engraftment, a significantly higher level than before transplantation. At 39 months post-transplantation follow-up the patient is alive and in continuous complete remission with undetectable levels of plasma HIV RNA on HAART.


CONCLUSIONS
The introduction of HAART has recently changed the paradigm of AIDS, allowing the control of HIV replication, the reduction of opportunistic infections, and the overall improvement of survival. One may therefore reconsider the current exclusion of patients with AIDS and a concomitant lethal malignancy from programs of high-dose chemotherapy and stem cell transplantation, as suggested by this report.
Sorà
Federica
F
Istituto di Ematologia, Università Cattolica Sacro Cuore, Rome, Italy.
Antinori
Andrea
A
Piccirillo
Nicola
N
De Luca
Andrea
A
Chiusolo
Patrizia
P
Cingolani
Antonella
A
Laurenti
Luca
L
Rutella
Sergio
S
Ortona
Luigi
L
Leone
Giuseppe
G
Sica
Simona
S
D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000628:therapy*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000276:immunology / Q000628:therapy*; D012367:RNA, Viral / Q000097:blood; D012074:Remission Induction; D014184:Transplantation, Homologous; D014766:Viremia / Q000517:prevention & control
D018952:Antigens, CD34; D012367:RNA, Viral; D016572:Cyclosporine