Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant
 

They should wait until a follow-up and the use of lab rats before they announce this.

Too late.

Uh...it is obviously too late for them to wait. ;)

I know, I know lol

So Magic Johnson's money isn't the cure?

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They really need more testing to confirm this. If this is true, that would be amazing and wonderful, but I totally concur that they kind of jumped the gun on this announcement.

Well, it's not like he had the stem cell transplant to treat his HIV, anyway. He had leukemia. I don't know if anyone would advocate taking a very dangerous treatment like a transplant to treat HIV which for many people is well treated with multi-drug therapy. It's interesting that he had this outcome...not so applicable for the bigger picture.

Drug treatments are relatively effective, sure - but they aren't particularly cost-effective, and if a one-time transplant can eliminate any future risk, it might be preferable over, say, 50 years of continuous drug cocktail, right? (not that the transplant is cheap, either, but I'm sure you see what I'm getting at)

I do agree that it's likely more of a curiosity than anything else at this point, though - particularly as a one-off in a poorly-controlled environment.

Transplant can kill you.

Taking the wrong drug cocktail can kill you. A bus that hits you in the crosswalk as you leave the HIV clinic can kill you. Et Cetera.

And I agree that this would be awesomely amazing if it were a concrete cure but they def jumped the gun on this one. I'd be interested to see what effect this has on the stem cell research debate if it's "proven" that stem cells can cure HIV.

Couldn't this guy just be the stem-cell version of the guy who had reportedly entirely fought off HIV within his own body? I'll have to see if I can find that story.

Blah blah, needs more tests, blah blah. Also, how do you guarantee a supply of blood from people with that gene mutation? Where's DS and his philosophical question thread: would you require people with the mutation to donate stem cells to save the lives of others?

ETFix a mistake

It's their civic duty!

http://www.blackfive.net/photos/unca...tivation03.jpg

Yeah, but in medicine, we don't exactly treat patients with dangerous remedies when less dangerous methods do a good job. Comparing the risk of a bus hitting you as you cross a street to the risks of a stem cell transplant displays a severe lack of knowledge of the risks involved. Taking "the wrong drug cocktail" is not a big risk. These drugs do have side effects, but stem cell transplants are VERY risky. Making light of that just shows your ignorance of the medical issues involved.

You can call me ignorant but you're being ignorant of my point: Ish happens. People die from all sorts of things so, if a person WANTS the all-or-nothing option, they should be allowed to do so if it's available.

I have personal recollection of a man who was treated with an HIV drug cocktail that DID kill him because it was the wrong combination of drugs for his body. Taking the wrong cocktail is "not a big risk" now but it wasn't always that way. There is reduced risk now because medicine is more advanced and the correct combinations can be pinpointed without so much trial-and-error. Who is to say that, if this option were worth pursuing and the proper research was done, stem cell research wouldn't be so risky for future generations? You speak as though stem cell transplants will always carry the risk they do now but given how many have said more research and testing should have been done before this announcement, I would think it'd be obvious that this thread isn't solely about the possibility of today.

Hmm, it says he received the transplant in 2007. They said he was fine and HIV-free in 2009, almost two years ago now. Sounds like they've given this time before releasing it to the public.

"Ish happens" and "people die from all sorts of things" is a horrible foundation for the legal and regulated practice of medicine.

LOL. AOIIAngel is in the medical profession and she's just stating the risk of these transplants. She isn't pretending to be able to tell the future. You speak as though anyone definitively knows what these transplants will carry in the future.

These stories reveal exploratory findings and that's why they should hold off until there are more tests. They shouldn't get anxious people all excited over something that might cure HIV or might turn the patient into an HIV infected unicorn. Ya never know and shit happens, right?

This made me think Kevorkian.

IIRC, patients go through trial-and-error with cocktails to make sure that they're getting the right combination. Once that's found, the risks go down greatly. Transplants/surgeries/etc carry a much greater risk, even with our advancements in medicine.

Re: "all-or-nothing" - Just because a patient thinks s/he knows what's best doesn't mean s/he actually does know what's best.

I think the point is that this is one case. They should have waited until more tests were done before giving everyone a potentially false sense of hope.

You know I'm a physician, right? When we do informed consent, we don't get to just tell people, "Oh yeah, there are risks in everything...I mean, you could get hit by a bus walking across the road." Yes, there are risks in everything, but the levels of risk are different and have to be quantified. You don't really need to instruct me in why HIV meds are better now than they used to be...I'm quite aware of the medical advances which you so poorly elucidated. Your recollections, however, are incorrect, the man you recall that died from a "wrong combination of drugs for his body" is not an accurate description of HIV therapy. Drugs are NOT prescribed based on anyone's "body type." He may have had side effects from the drugs, but he didn't have the "wrong combination" unless someone just made a gross mistake.

I understand that this is research, but if you'd READ my original post, you'd see that the point I was making was that the consequence of being cured of HIV was really just a side benefit of being treated for leukemia. It was not to primary goal of therapy. While people might think of this as future therapy, IMHO (which I get to have with a little more credibility than you, btw) it is not very likely due to the high risks involved with the treatment. Yeah, it's great if you can cure a disease that kills 25% of people that are infected in 10 years (using assumed stats for emphasis) but kills 50% of patients treated in less than 2 weeks. Those risks are greater than the risk of the disease itself.

The findings were reported in a journal of medicine, which the average person does not read. When you release such findings to the general public, you need to be able to say more than "the transplant appeared to wipe out both diseases...."

The doctor who treated him in 2009 says the man has no signs of HIV. They do not know whether this is a "cure" or whether using the word "cure" is a leap.

Ah yes, fair enough. I still can't feel anything but elated at this news though :D

While the word "cure" is a leap in my opinion also, it doesn't mean that this isn't a bigger step to finding a cure.

Now it was a transplant, but later could the info they learn from transplants be a vaccine? Who's to say?
Regardless, the story itself is interesting

Which is exactly why this announcement was premature.

Um, it's good news. Even if it isn't a cure.

It is good news for that man with hope that the leukemia and/or HIV do not "come of out remission."

The whole article sounded like a House episode to me.

"Let's infect him with malaria to cure him of XYZ disease!"

And here everyone is going all Cuddy on this guy. For shame. :p

AOII Angel... If I understand correctly, the premise of this "cure" is that they wipe out the patient's bone marrow completely, transplant new stems cells into the patient that have an HIV resistant gene, and then the new CD4 cells are HIV resistant, correct?

It has been a little while since my last virology and immunology classes, but isn't HIV a rapidly evolving/mutating virus? I know in patients on the highly specialized drug cocktails, resistance is being seen due to medication non compliance.

Would the same not be possible for such a therapy as this?

I imagine it's a race between the immune system and the virus.

And it's even possible that the chemotherapy had an impact on the virus's reproduction too that's not being accounted for here. Or the cancer competed with the virus for resources, or fought the virus in little sword fights in the flood stream. They don't even know for sure that the stem cells caused it, much less why it worked.

This man: Andrew Stimpson is the one whose body apparently fought off the disease. Here's the story:
http://www.timesonline.co.uk/tol/new...icle589783.ece

He was positive, now he's negative.

/leaves the rest for Dr.Angel :p

Let me start over--I'm fully aware of your profession and I'm not arguing with you on medical fact nor am I saying I know more than you do because I don't. Nor am I completely without intelligence, so you don't have to lecture me on informed consents--I may not be a doctor but my line of work uses them, too. I know better than to say "here are the risks but you'll die anyway so go for it." If that's how it came across, then I fully retract that. However, I responded to the blanket statement "transplants kill people" which seemed to be your only rationale for why one should use drugs instead of transplants. So, what I was trying to point out (however "crudely") is that "transplants kill people" isn't an argument against the hope of a disease's cure or for further explanation of the option because they also save people once you get them right. So if that's not what you meant then we're on the same page.

For the record, since physicians really do have more credibility on these things than others, you should know it was a physician who made the assertion that the drug cocktail is what killed that man because it was not the right combination for him. If that's not a valid or true reason based on what you know then you would be completely right--that physician made a huge mistake (or he lied).

And we must keep in mind that since evolution is real, viruses become immune to medications over time. A non-pharmaceutical alternative to HIV treatment or cure is the only long-term solution. Yes, bone marrow transplant is ugly, dangerous, painful, expensive, etc. etc., but if they can replicate this study it will be excellent news. My guess is the part of the story they're not telling is that the study IS at some stage of replication now.

The question I have for AOII Angel (and I'm glad to find out you are qualified to speak to the issue) is, is there a difference between a stemcell transplant and a bone marrow transplant? I thought I knew what bone marrow transplants were and then an aunt of mine got leukemia, and her treatment was much different than I thought it would be.

I used to work at a medical research facility that is a world-leader in stem cell research, and I continue to be very hopeful for a myriad of diseases stem cells can cure, particulary MS.

It seems that many people are ignoring the fact that this is not just a stem-cell transplant, but a transplant from a matching donor with a rare genetic mutation that is known to increase HIV resistance. Replicating this treatment in a study will be incredibly difficult as well as ethically tricky. It may be something that is replicated on a case-by-case basis with individuals with cancer and HIV who have the money and time to wait for a matching donor with the mutation rather than in an ongoing study due to the risks of the treatment for both donor and recipient.

This is the rest of the article:
All of the doctors in the article are being very specific about the ramifications of this possible cure. I can't even fault article since they've covered all of the downsides as well. I'm not sure what more the people in this thread complaining about publicizing it without further studies want, as the article was first published in 2009 in a medical journal - one can reasonably assume with even more detailed caveats - and no one in that article claims it to be a cure for all with HIV.

The HuffPo article is a blog post and not nearly as well written, but still, original source covers all the important bits.

The article you quoted was in the AMA Morning Brief today.


There are just so many problems with the treatment.

• You really don't want to completely wipe out the already failing immune system of a person already ravaged by opportunistic infections.
• Full body irradiation is incredible dangerous. It's not just something you "try".
• Trying to find a proper bone marrow match is difficult as is: trying to find one with the exact mutation is much more difficult, especially since 1% of Caucasians have the mutation and 0% of blacks do. Not all of these people will be able to donate, because they will have their own illnesses (autoimmune, cancer, etc.) too.

There's a million more complications, including getting bone marrow donations repeatedly from the few people who qualify for bone marrow donations. It would be awesome if this were the cure, but at least at the current moment, I just really don't think it is.

The cool thing, as the article stated, is that scientists know that they correctly understand how HIV/AIDS works. Consequently, even though this probably won't end up being a cure for AIDS, scientists may be closer because they know they're on the right track.

Like I said before, this would be amazing if it were true. There's just many more steps to look at and evaluate before anyone could consider it even possible as such.

Close, but he was being treated for leukemia, not HIV. The BM transplant was done only for his leukemia.

Did they even say what kind of leukemia the guy was being treated for? I couldn't find it. If it was a T-cell leukemia, you could even hypothesize that THAT was what cured his HIV, rather than the transplant....

HIV does rapidly evolve/mutate. I don't think anyone knows if the virus will be able to figure out a way to infect these naturally resistant people. Is it a possibility? Anything is a possibility. HIV has been around more than 20 years so far and hasn't figured it out yet, though. I'll have to ask my friend who is an Infectious Disease specialist what the mutation actually does to provide resistance. We are having dinner tonight so I'll get back to you.

You were responding to one post I made to respond to someone else. I had actually made a much more detailed post than, "Transplants kill people." Please see the post below by AOEforme for more details of the risks of Bone marrow and stem cell transplants. As for my comments about drug cocktails. Yes, people can die from complications from their medications. NOT because they were the "wrong ones for their bodies." That was your interpretation of the doctor's assertion. Doctors don't discuss medications in that context because we don't think of medications that way.
I also never said that medications were the end all be all of HIV treatment, and that we should stop looking for a cure. Medications can have some really nasty side effects. Unfortunately, this is not a reasonable cure.

Yes, there are differences between bone marrow and stem cell transplants. The bone marrow is just generalized, differentiated blood cells while stem cells are cells that have to potential to become any kind of cell. When using stem cells for this type of transplant to replace blood elements, you have to eleminate the entire bone marrow of the recipient to be able to replace it with the stem cells. Stem cells, however, can be used to transplant for other cells, as well, hopefully. (ie. nerve cells for MS or parkinsonism, pancreatic islet cells for diabetes type 1) They wouldn't be done like a bone marrow transplant in those cases.

Thanks for posting this, AOEforme. Hopefully scientists are moving towards a cure for HIV, maybe a vaccine. I think this just demonstrated, yet again, that a special subset of patients have resistence to HIV infection. Hopefully that will be useful in some way.

This cure is the beginning of the zombie apocalypse.

Right, but drugs that manage (rather than eliminate) infections, particularly viral infections that mutate rapidly, are incredibly problematic in their own right, aren't they?

There's no guarantee that the current treatment methods won't lead to an increase in resistant strains (and, to be fair, no guarantee that stem-cell immunity won't be subject to mutation as well) - in fact, it's fairly likely that current best practices for AIDS aren't a long-term solution to the epidemic, right?

I realize there's a balancing point and that the oath you took carries incredible weight, and that it's clearly the best way to look at it from a single-patient standpoint. However, it seems that, from an epidemiological standpoint, the stem-cell method is worth exploring as a much-preferred long-term solution.

This post had many more hyphens that I initially anticipated ... more coffee I guess? :p

There are no guarantees in life. Of course we need to keep looking into newer and better treatments for HIV/AIDS. Please read the AMA Morning Brief posted by AOEforme as to why this is not likely to be a longterm solution to the problem of the HIV epidemic. They may put more research into this, but extrapolating a cure for all HIV patients from one patient who was "cured" after receiving treatment for leukemia and incidentally also having his HIV infection cleared from his body is a FAR stretch at this point.

... which is why my initial post labeled this a "curiosity" rather than anything to hitch wagons to.

That doesn't change the implications though.

^^Pretty much.
I clearly just said that these are words the doctor spoke--I did not interpret, I repeated. Just because physicians should not speak to certain contexts does not mean they do not and this one apparently did. If something was mispoken, it does not automatically get attributed to me just because I am not a doctor. ;)

I hear your point very clearly and as I said before--if you were not intending to make a blanket statement that all "transplants kill people" (and you say you weren't) then we are on the same page.
What the heck, DS? Just....just.....this is not Dawn of the Dead.

What's significant about this is not that it is a practical cure, but rather that a cure might be possible, and this opens up directions of research.

The idea is that someone with a compromised immune system, when getting bone marrow that has stem cells that cannot get infected with HIV, can get HIV out of their system.

The stuff described in the article shows the case of a very lucky man who got HIV out of his system by an extremely high risk method that was only taken because leukemia would have killed him otherwise.

Now, it brings the idea: suppose if someone were able to modify all existing bone-marrow cells to be immune to HIV and do so safely, that should cure HIV. The hard part is: how do you do it safely?

This is just like how 150 years ago, any open fracture almost certainly means loss of limb because you are almost certain to get an infection, which then leads to death if nothing is done. They knew that everything should be OK as long as the limb does not get infected. How to keep the limb sterile is the hard part, and that was not solved until antiseptics were invented.

Here, the challenge lays in how to make all the cells in the patient HIV-proof without having a 50% chance of killing the patient.

You just added a very important word to the sentence that I did not. I also suspect if you are repeating your physician's statement word for word that he was trying to use layman's terms for you. Some people do a very poor job of converting medical jargon into layman's terms. Also, there is a very well known phenomenon in medicine where people hear what a physician said then when repeating it change it significantly...kinda like that game of telephone. Anyway, I'm tired of this argument about nothing. You jumped into the middle of a conversation without considering the backstory. Accept that we agree that we need a cure but this is probably not it.


BTW, DDD lady, I asked my friend about the resistance to HIV seen in some people. He said that most of our T-cells have two receptors that HIV uses to enter the cell. The first receptor is used to initially enter the cell, but in the vast majority of patients, after initial infection, the virus changes and begins entering the cell only through the second receptor. Some lucky patients only have the first receptor in their T-cells. Once the virus changes the virus cannot reinfect more cells and is unable to reproduce. The virus will be eradicated. The patient in the study was transplanted with cells that only had the first receptor so his HIV viruses had no way of entering his new cells, thus dying off. I think the thought is that HIV would not be able to mutate to enter the new cells through the other receptor because there is no place for them to go to replicate after the transplant. BTW, he agreed that this was a lucky single case finding for the patient with little practical application for his patients in the future. (unless, of course, one of them has leukemia and needs a BM transplant :) )