Reacción a "A stem cell transplant with only one protective mutation achieves remission of HIV in a cancer patient"

This is a very detailed, high-quality study that confirms the cases previously published of remission of HIV-1 infection through haematological stem cell transplantation from a donor. As in previous cases, this involves a person with cancer who required this medical intervention as therapy, and in which the impact of the transplant on HIV-1 infection is explored in parallel.

Notably, the donor and recipient both had the CCR5 delta32 mutation in heterozygosity rather than homozygosity, as was the case with previous transplants. This brings it closer to the Geneva case we published last year within the IciStem cohort, in which both the donor and recipient completely lacked the mutation and are also currently in remission. The other feature is the functional evidence, also previously noted in the Geneva case, that immune cells called natural killers play an interesting role around the time of transplantation.

Last year, we proposed in an article in Lancet HIV that the mechanism of drastic reduction of the viral reservoir is due to a phenomenon of alloreactivity that we call donor allogenic immunity and that the mutation would be an extra to prevent possible reactivation of very minor viruses that could remain present after transplantation. Therefore, remission is easier if the mutation is present, but it is not essential.

[Regarding possible limitations] We must remember that this type of medical intervention is reserved exclusively for people with severe haematological disease, but alternative strategies are being worked on.