Transplantation and the HIV Latent Viral Reservoir

Despite antiretroviral therapy, the latent viral reservoir (LVR) remains the primary barrier to HIV cure. Both hematopoietic and solid organ transplantation (SOT) have provided optimism for cure and significant insights into LVR composition and maintenance. There have been thirteen reported cases of acquired cure, all in individuals receiving allogeneic hematopoietic stem cell transplants (allo-HSCT). While infeasible for most, these cases have provided important lessons about the LVR. Impacts of SOT on the LVR have also been investigated. In kidney transplantation where recipients were T-cell depleted, the LVR initially decreased before rebounding, and eventually surpassed the LVR of recipients without T-cell depletion. Despite transplanting a large lymphoid organ, studies have found no impact of HIV+ liver transplants on LVR size in recipients. Given that SOTs are more accessible globally than allo-HSCTs, lessons learned about the LVR from these studies can inform potential cure avenues that may be more feasible and attainable.