Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant

[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?

[knight_shadow]

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.

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.

Originally Posted by thetaj

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.

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.

[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.

[DrPhil]

Originally Posted by thetaj

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.

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.

[thetaj]

Originally Posted by knight_shadow

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.

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

[nittanygirl]

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

[Kappamd]

Originally Posted by thetaj

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

Which is exactly why this announcement was premature.

[thetaj]

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

[DrPhil]

Originally Posted by thetaj

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."

[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.

[DDDlady]

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?

[Drolefille]

Originally Posted by DDDlady

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

[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).

[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.

[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. 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:

“It’s hard enough to get a good compatible match for a transplant like this,” Fauci told FoxNews.com, “But you also have to find compatible donor that has this genetic defect, and this defect is only found in 1 percent of the Caucasian population and zero percent of the black population. This is very rare.”

Fauci said while this patient is “functionally cured” this is not something you can do with every HIV-infected individual.

“This is not prime time to me at all,” he said. “This is a very unusual situation that has little practical application for a simple reason. This donor not only had to be a good compatible match, but the donor had to have a genetic defect of cells that do not express the receptor that the HIV virus needs to enter the cell.”

Fauci also pointed to the fact that this transplant process is not only expensive, it’s incredibly painful and complicated, and requires the patient to start a whole new regimen of drugs.

“This patient is trading one poison for another. He may not have to be on antiretroviral drugs anymore, but he has to take immunosuppressant drugs now to prevent the rejection of his transplant cells. Again, what this is, is an interesting proof of concept, but it’s absolutely impractical.”

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.