Impact of alemtuzumab on HIV persistence in an HIV-infected individual on antiretroviral therapy with Sezary syndrome

AIDS
Thomas A RasmussenSharon R Lewin

Abstract

To study the effects of alemtuzumab on HIV persistence in an HIV-infected individual on antiretroviral therapy (ART) with Sezary syndrome, a rare malignancy of CD4 T cells. Case report. Blood was collected 30 and 18 months prior to presentation with Sezary syndrome, at the time of presentation and during alemtuzumab. T-cell subsets in malignant (CD7-CD26-TCR-VBeta2+) and nonmalignant cells were quantified by flow cytometry. HIV-DNA in total CD4 T cells, in sorted malignant and nonmalignant CD4 T cells, was quantified by PCR and clonal expansion of HIV-DNA assessed by full-length next-generation sequencing. HIV-hepatitis B virus coinfection was diagnosed and antiretroviral therapy initiated 4 years prior to presentation with Sezary syndrome and primary cutaneous anaplastic large cell lymphoma. The patient received alemtuzumab 10 mg three times per week for 4 weeks but died 6 weeks post alemtuzumab. HIV-DNA was detected in nonmalignant but not in malignant CD4 T cells, consistent with expansion of a noninfected CD4 T-cell clone. Full-length HIV-DNA sequencing demonstrated multiple defective viruses but no identical or expanded sequences. Alemtuzumab extensively depleted T cells, including more than 1 log reduction in total T cell...Continue Reading

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Citations

Dec 14, 2017·Frontiers in Immunology·Casey K Hua, Margaret E Ackerman
Jan 11, 2018·Retrovirology·Xiao Qian Wang, Sarah Palmer
Jan 31, 2018·Retrovirology·Alexander O Pasternak, Ben Berkhout
Jan 19, 2020·American Journal of Clinical Dermatology·Lisa MorrisMadeleine Duvic
Sep 27, 2019·Frontiers in Immunology·Camille E PuronenThomas S Uldrick
Jun 12, 2020·Clinical Microbiology Reviews·Joshua S DavisMichael Boyle

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