The power of ten in HIV remission: insights from hematopoietic stem cell transplantation.

Abstract

Purpose of review: This review discusses emerging insights from ten cases of HIV remission following allogeneic hematopoietic stem cell transplantation (allo-HSCT). With more than 40 million people living with HIV and current therapies offering lifelong control but not cure, these rare cases of viral remission provide timely and valuable perspectives for designing curative strategies.

Recent findings: The review synthesizes clinical experiences from cases such as the Berlin, London, Düsseldorf, City of Hope, and New York patients. These cases have demonstrated that that the achievement of full donor chimerism and the presence of the CCR5Δ32 mutation significantly enhance the likelihood of HIV remission. However, recent evidence, including the Geneva patient, shows that remission may also occur without the mutation, suggesting a pivotal role for alloreactivity in clearing viral reservoirs. Studies also highlight virological, hematological, and immunological markers that are critical for monitoring remission and informing safe interruption of antiretroviral therapy.

Summary: Although allo-HSCT is not scalable for all persons living with HIV due to its risks and complexity, the ten cases of remission addressed here have deepened our understanding of HIV persistence and eradication mechanisms. The insights gained may guide the development of more accessible and safer cure strategies in the future.