Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant

[AOII Angel]

Originally Posted by christiangirl

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.

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.

[christiangirl]

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. 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.

[DrPhil]

Originally Posted by christiangirl

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.

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

Originally Posted by christiangirl

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.

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?

[AOII Angel]

Originally Posted by christiangirl

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.

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.

[christiangirl]

Originally Posted by AOII Angel

You know I'm a physician, right?

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).

[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 )