Question

7. Bone Marrow transplants from R5 negative donors has been tried since success of The Berlin Patient, most of these patients died. Which of the following has NOT been found to be a cause of these deaths. (A) R4 tropic virus breakout (C) secondary infection (B) radiation induced lymphoma (D) R5 virus rebound 8. Advances in antiretroviral therapies have increased HIV positive life expectancy, particularly in wealthy countries. However, life expectancy has NOT increased even with better drugs for (A) intravenous drug users (C) Men who have sex with men (MSM) (B) patients who start drugs with low CD4 counts (D) both A and B

Answer 1

7.B radiation induced lymphoma

a 40-year-old man living in Berlin, had been diagnosed with HIV-1 infection 10 years earlier and had been on a suppressive antiretroviral regimen including tenofovir (TDF), emtricitabine (FTC), and efavirenz (EFV) for four years prior to his AML diagnosis. The patient underwent two courses of induction chemotherapy and a single course of consolidation therapy, but his AML relapsed, necessitating HSCT. Due to the foresight of the patient’s hematologist, an HLA-identical donor homozygous for the CCR5Δ32 allele was identified. The patient received anti–thymocyte globulin, cyclophosphamide, and TBI in preparation for the transplant; mycophenylate mofetil and cyclosporine were administered after HSCT to prevent GVHD. Although ART was interrupted at the time of HSCT, HIV-1 RNA remained undetectable in serum. Proviral HIV-1 DNA became undetectable in PBMCs after full chimerism was achieved on posttransplant day 61. Despite relapse of AML nearly one year later, HIV-1 RNA and DNA remained undetectable. The patient underwent a second HSCT from the same donor and has had sustained remission of AML and HIV-1 infection ever since. As of this writing, the patient has been free of detectable HIV-1 infection for approximately eight years without any ART. Extensive sampling of blood, rectal tissue, lymph node, cerebrospinal fluid, and brain has failed to yield confirmable evidence of persistent HIV-1. Thus, for all intents and purposes, this patient may be considered cured of HIV-1 infection.

18. B

Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4+cell count significantly improve their life expectancy if they have a good CD4+ cell count response and undetectable viral load.