Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant

[AOEforme]

Originally Posted by Drolefille

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.

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.

Originally Posted by psusue

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.

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....

[AOII Angel]

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?

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.

Originally Posted by christiangirl

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).

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.

Originally Posted by DubaiSis

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.

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.

Originally Posted by AOEforme

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....

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.

[DaemonSeid]

This cure is the beginning of the zombie apocalypse.

[KSig RC]

Originally Posted by AOII Angel

Yeah, but in medicine, we don't exactly treat patients with dangerous remedies when less dangerous methods do a good job.

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?

[AOII Angel]

Originally Posted by KSig RC

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?

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.

[KSig RC]

Originally Posted by AOII Angel

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.

[christiangirl]

^^Pretty much.

Originally Posted by AOII Angel

That was your interpretation of the doctor's assertion.

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.

Originally Posted by DaemonSeid

This cure is the beginning of the zombie apocalypse.

What the heck, DS? Just....just.....this is not Dawn of the Dead.

[excelblue]

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.

[AOII Angel]

Originally Posted by christiangirl

^^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.

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 )