Torlontano G, Di Bartolomeo P, Di Girolamo G, Angrilli F, Verani P, Maggiorella M T, Dragani A, Iacone A, Papalinetti G, Olioso P
Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Roma, Italy.
Haematologica. 1992 May-Jun;77(3):287-90.
A 26-year-old man with AIDS-related complex (ARC) was treated with high-dose busulphan and cyclophosphamide, followed by allogeneic bone marrow transplantation. For 3 months before transplantation he received a combination of four drugs considered active against human immunodeficiency virus (HIV) to reduce the viral burden: zidovudine, acyloguanosine, fusidic acid and phenylidantoin. Although in reduced doses in coincidence with marrow engraftment, zidovudine therapy was scheduled after transplantation in order to protect donor cells from infection with HIV. Engraftment rapidly occurred and was documented by cytogenetic analyses. The post-transplant course was characterized by severe acute GvHD with irreversible hepatorenal failure. The patient died on day 48 after transplantation. Polymerase chain reaction analyses for detecting HIV DNA showed the persistence of positivity at day +30 and +45 after transplantation. Antibodies to specific HIV proteins evaluated with Western blot testing also persisted at days +21 and +35 after transplantation. Circulating immunocomplexes disappeared on day +31, and an increase in the CD4/CD8 ratio occurred. The short survival of the patient, affected by chronic hepatitis too, does not allow final conclusions about the role of BMT in HIV disease.
一名患有艾滋病相关综合征（ARC）的26岁男性接受了大剂量白消安和环磷酰胺治疗，随后进行了异基因骨髓移植。在移植前3个月，他接受了四种被认为对人类免疫缺陷病毒（HIV）有效的药物联合治疗，以减轻病毒负荷：齐多夫定、阿昔洛韦、夫西地酸和苯妥英。尽管在骨髓植入时剂量有所减少，但移植后仍安排了齐多夫定治疗，以保护供体细胞免受HIV感染。植入迅速发生，并通过细胞遗传学分析得到证实。移植后的病程以严重的急性移植物抗宿主病（GvHD）和不可逆的肝肾衰竭为特征。患者在移植后第48天死亡。用于检测HIV DNA的聚合酶链反应分析显示，移植后第30天和第45天仍呈阳性。用蛋白质印迹试验评估的针对特定HIV蛋白的抗体在移植后第21天和第35天也持续存在。循环免疫复合物在第31天消失，CD4/CD8比值增加。由于该患者还患有慢性肝炎，生存期较短，因此无法就骨髓移植在HIV疾病中的作用得出最终结论。
