Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant

[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.

[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.

[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

[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."

[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

[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.

[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.

[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.