Challenges to Stem Cell Transplantation in HIV-Positive Patients

Published: October 21, 2014

Barbara Jungwirth
Original Article:

Stem cell transplants have gained interest in the HIV community mainly because of their potential for curing HIV itself. However, stem cell transplants are mainly used to treat various forms of cancer in both HIV-negative and HIV-positive people. In 2012, a total of 18,284 hematopoietic (blood cell) transplants were performed in the U.S., according to the U.S. Health Resources and Services Administration. Data on how many of these involve HIV-positive patients are not available, but Christine Durand, M.D., of Johns Hopkins School of Medicine, estimates that over time "hundreds" of HIV-positive patients have received stem cell transplants.

Durand spoke at the recent 54th Interscience Conference on Antimicrobial Agents and Chemotherapy about the unique challenges of stem cell transplantation in HIV-positive recipients. Twenty-five percent to 35% of HIV-related deaths are due to cancer, mainly Hodgkin and non-Hodgkin lymphoma, acute leukemia and multiple myeloma. However, there are concerns about the risk of bacterial and viral infections in HIV-positive cancer patients, especially during the pre-transplant conditioning stage.

Two case control studies of autologous (cells are from the patient him- or herself) stem cell transplants showed slightly lower survival rates for HIV-positive patients compared to the HIV-negative control group (61.5% versus 70% in a total cohort of 106). Sixteen percent of the 19 deaths in the HIV-infected group were related to infections during the first four months after the transplant, while none of the 14 deaths in the control group were due to infections. However, the probability of overall survival evened out between the two groups a little more than one year post-transplant.

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