HIV Remission and Immunotherapy: A New Era of Clinical Advances

A 60-year-old patient achieved sustained HIV remission after a heterozygous CCR5Δ32 stem cell transplant. This case demonstrates that donor cells carrying a single CCR5Δ32 allele can support long-term viral control, and it broadens donor-selection considerations: when CCR5Δ32 homozygous donors are unavailable, heterozygous matches may be clinically meaningful.

Prior remissions reported in the literature focused on donors homozygous for CCR5Δ32; by contrast, this case used donor cells with only one copy of the variant, expanding the practical donor pool for programs where homozygous donors are rare.

The patient underwent allogeneic transplant for a hematologic malignancy, later discontinued antiretroviral therapy (ART) after a sustained post-transplant interval, and showed no evidence of replicating HIV six years after transplant.

A plausible explanation is that donor heterozygosity for CCR5Δ32 reduced the pool of CCR5-expressing target cells. In combination with graft composition, conditioning intensity, and immune reconstitution, this may have favored donor-derived immune surveillance.

For post-transplant management, decisions about ART interruption must remain protocol-driven. Recommend frequent plasma HIV RNA testing with ultrasensitive assays, periodic cell-associated HIV DNA/RNA measurements, and archived-sample baseline comparisons before any ART cessation. Current evidence does not support routine ART interruption outside controlled research settings. Immune processes—graft-versus-reservoir effects, reconstituted adaptive responses, and innate antiviral activity—likely contributed to clearance; combined immunotherapy strategies merit systematic evaluation to augment these effects.