An Update On The First "Cured" AIDS Patient

[Peter Staley]

I know the story was posted in the Research forum, but I'm plugging my blog posting about it here:

http://blogs.poz.com/peter/archives/2008/11/an_update_on_th.html

If you comment here, please cut & paste it below my blog entry as well.

[HALOO]

If there is first. there will alway be second.
 I pray that they will do intense research on this and pray that second cure person wil come soon.

[dixieman]

Its still too early to call it a cure...I would call it ... in remmisson... same as in cancer patients... but, it does bring Hope!

[HALOO]

Have a Question, Do you test Postive or Negative??

[HALOO]

I am sorry, I mean he(the Patient)

[red_Dragon888]

does it mean that Aids resides in the bone marrow?  maybe that is the best place to attack the virus.

[newt]

I am most interested to know whether this only works if you have leukaemia, it seems kinda important.

This is v hot intervention as proof of concept and worth following, I hope we can entice the good doc to England to talk to us at some point

- matt

[denb45]

Have a Question, Do you test Postive or Negative??

it SAYS:   "Doctors have not been able to detect the virus in his blood for more than 600 days"
I would assume that he tests NEG and is Undetectable..........if this is a fact, that's very hopeful

[Peter Staley]

That's right.  After the transplant -- basically wiping out his old immune system and giving him a new one -- he'd start with no antibodies to HIV.  If his new immune system found some HIV, he'd start producing antibodies.  But since they've found no HIV, then he'd test negative on an antibody test.

[HollyStar]

WOW!!! Quite an amazing article. I'm curious about the drug Pfizer has, will it start trials soon? Thanks for posting this, you got us excited tonight!

[Cliff]

How risky are bone marrow transplant?  Would it be unethical to perform one on an HIV patient without leukaemia? 

Was he on treatment post transplant?  I'm a bit confused by it all.  If he received a new immune system, but HIV was still harboring in non-immune system cells, wouldn't the virus simply come back at some point?  Or am I wrong in believing that HIV also reside in non-immune cells (latent state)?

[Grasshopper]

How risky are bone marrow transplant?  Would it be unethical to perform one on an HIV patient without leukaemia? 

Was he on treatment post transplant?  I'm a bit confused by it all.  If he received a new immune system, but HIV was still harboring in non-immune system cells, wouldn't the virus simply come back at some point?  Or am I wrong in believing that HIV also reside in non-immune cells (latent state)?

http://online.wsj.com/article/SB122602394113507555.html           :

"Caveats are legion. If enough time passes, the extraordinarily protean HIV might evolve to overcome the mutant cells' invulnerability. Blocking CCR5 might have side effects: A study suggests that people with the mutation are more likely to die from West Nile virus. Most worrisome: The transplant treatment itself, given only to late-stage cancer patients, kills up to 30% of patients"

"Doctors have not been able to detect the virus in his blood for more than 600 days, despite his having ceased all conventional AIDS medication."

"Most researchers there believed some HIV still lurks in the patient but that it can't ignite a raging infection, most likely because its target cells are invulnerable mutants."

[GSOgymrat]

Very interesting. I see this case as a fluke but one that could lead to future treatments.

[randym431]

My other half has a type of leukemia called CML. Very rare. He does NOT have HIV.
He went on med treatment for the leukemia that targets CML type leukemia only, and is so effective that they call this pill "the magic bullet".
He's been leukemia free for 5 years now.
But 5 years ago after diag of CML leukemia, a marrow transplant was talked about.
It is EXTREMELY risky. If you have a twin, then a bone marrow transplant is more promising. If not, then your chances are very poor.

If you’re a young 25 years old or under, the outcome is like 60-75% you will live or survive a bone marrow transplant.
If your 40 years old or over, the chances are like 40% you'll survive.
Basically  a bone marrow transplant consists of totally destroying your current immune system via radiation, then injecting bone marrow from a donor to take hold and grow in your body.

Problem is, unless you have a twin with a perfect match, the body can reject the transplant, like with any organ transplant. Also, the period between when your marrow is destroyed by radiation, and when the new transplant grows enough to take hold, you can catch all the same OI's as with AIDS and a cd4 of zero.

Most people that do not survive a bone marrow transplant die during this period when they have no immune system because the new transplanted marrow has not taken hold yet. That can take 4 to 6 months for this new marrow transplant to gain enough strength to give you your immune system back.

And like I said, if your 40 years old or older, the chances are only around 40% you'll survive to the point this new marrow transplant in your body can fight on its own.
So in short, a bone marrow transplant is not an option for curing HIV.
HIV meds and controlling the virus would be the safest way to go, side effects and all.

If I had the option of taking meds for life and remaining undetectable, or a possible cure with a bone marrow transplant, I'd go with the pills. UNLESS you have a twin. A twin sister or brother bone marrow is a perfect match, and the chances are much better for survival. Still very risky.

[Sweet_C]

Um, I'll pass on the bone marrow transplant.

[aliveinla]

It's not pratical that everyone gets transplant but the hope here I think is to go down this path and find a way to cure w/o tansplant.

Just another hope. one more good news for us since 11/4 other than that damn prop 8.

[leit]

If you’re a young 25 years old or under, the outcome is like 60-75% you will live or survive a bone marrow transplant.
If your 40 years old or over, the chances are like 40% you'll survive.

Really sobering percentages! I didn't think they were so low...

[leit]

I am most interested to know whether this only works if you have leukaemia, it seems kinda important.

What are you thinking about, "newt"?

Schematically, apart from leukaemia, there were three steps:
1 - conditioning (chemo and radiotherapy);
2 - transplant of homozygote CCR5delta32 bone marrow (BTW, the patient was already CCR5delta32 heterozygous, but I don't think that counts);
3 - anti-rejection therapy (I suppose).

My question: Considered that both chemical (Selzentry, CCR5 antagonist) and biological (PRO 140, anti-CCR5 monoclonal antibody) drugs which should mimic a defective/deleted CCR5 condition yield far from great results, which is/are the "secret number/s" of dr. Hütter's "miracle" - 1, 2 or 3???


P.S. The WSJ article reads that, in 1989, "a 41-year-old patient with AIDS and lymphoma underwent radiation and drug therapy to ablate his bone marrow and received new cells from a donor. It is not known if those cells had the protective CCR5 mutation, because its relation to HIV hadn't been discovered yet. But after the transplant, HIV disappeared from the patient's blood. The patient died of his cancer 47 days after the procedure. Autopsy tests from eight organs and the tumor revealed no HIV." Do we want to believe that BY CHANCE that patient received a super-rare homozygote CCR5delta32 bone marrow, or... is myeloablation that counts?

[gerry]

How risky are bone marrow transplant?  Would it be unethical to perform one on an HIV patient without leukaemia? 

In addition to what Randy described as the immediate risks from knocking off one's immune system completely in order to allow the new bone marrow transplant to take, there are other complications to be aware of.  This includes Graft vs Host Disease or GVHD in which the new bone marrow immune cells can actually mount an immunologic attack against the host cells.

It's a very fascinating treatment to have the option and capability of using, but also quite scary.  The story itself is fascinating.  The transplant would probably not be the answer in this puzzle; it would lie more along the lines of developing strategies for furthering gene therapy instead, which this transplant experiment has shown that it can actually work.

[gerry]

Do we want to believe that BY CHANCE that patient received a super-rare homozygote CCR5delta32 bone marrow, or... is myeloablation that counts?

There have been other allogenic bone marrow transplant recipients in the past in which the transplant didn't halt the progression of HIV (link), so it's not likely the myoablation that's at play.  However, donate BM immune cells can mount a Graft vs Host Response (which is actually part of it's anti-tumor effect; if successful, the new immune response can kill remaining tumor cells that escaped high dose chemo and radiation), which may also potentially kill HIV-harboring host cells.  It's hard to say in the other case if this was what was at play or if he actually got a homozygous transplant, since he passed away within a month and a half following the transplant.

[Atripla_User]

i think this is awful, not what i would want to do.

[mecch]

I suspect as the years role on, we will see several utterly strange and wonderful cures, and equally rare. However, what we want to hope for is the "functional cure" that will apply to new sero-coverts, and ever better ARV for the average joe HIV poz. 
Also, as i said in another post today, I'll look forward to the miracle abyzymes that are going to eat that HIV right out of my reservoirs, like scrubbing bubbles with smiley faces...
I want my cure plainless to me, and mercilessly cold, efficient, and surgically precise against the virus, m*therF*cking life-stealing parasite that it is.

[weasel]

good news !

 What  kind of money we talking here ?

 would the V.A. do such a thing ?

*********************

 I just happen to HAVE  an Identical Twin brother , who has over the years  offered

 any organ or juice or what ever to make me better .

 How Painful would this sort of thing be to the person GIVING the bone marrow ?

  This sounds like a move in the good direction .

                                   let us all pray ,one day will we be free of HIV

                                   I offer my love and prayers to this person !
                                   Peter keep us updated 

                                                                         Karl

[Peter Staley]

Karl -- no one is suggesting here that bone marrow transplants are a viable treatment option -- they are not -- they're just too dangerous.

However, this case report does have very interesting implications for the study of potential gene therapies.  Unfortunately, the study of gene therapy is still in it's infancy, and it will be many years before they figure out how to make them work.

[weasel]

thanks Peter  ,

 I'll just have to settle for a loving visit from my brother 

  As you know I pray for all of this just to go away .

                                                bless us all  ,

                                                                     karl

[GregoryD]

i find this the most interesting development so far. i don't think a transplant is a feasible option but who knows what new treatments may come form this.

[Queen Tokelove]

I heard about it through a friend. And though the percentages is low for people 40 and over, I'll be 40 in January, I think I would take the chance. But more than likely there would be a list and my insurance wouldn't cover it.

[skeebo1969]

Karl -- no one is suggesting here that bone marrow transplants are a viable treatment option -- they are not -- they're just too dangerous.

However, this case report does have very interesting implications for the study of potential gene therapies.  Unfortunately, the study of gene therapy is still in it's infancy, and it will be many years before they figure out how to make them work.

  I recently read an article about a little boy receiving a bone marrow transplant in an attempt to cure him of sickle cell anemia.  According to the story, if I remember correctly,  he has been sickle cell free for 3 years now.  Different circumstances I know, but it does leave me to wonder what else is on the horizon when it comes to medical break throughs.

[hotpuppy]

My recollection is that they have to poke a hole in your bone to get the marrow in.  I don't recalll thinking it would be nice or pleasant.  In fact it  seemed more like middle ages torture.

as for the "cure"... I think it's more important to focus on what isn't being said.  This is all keyed to the CCR5 delta32 mutation.  It emphasizes that we need to be looking harder at entry inhibitors. 

there are 4 ways to deny HIV the R5 pathway.
1) Delta 32 mutation.
2) bone marrow from someone with a Delta32 Mutation transplanted to someone who doesn't ahve it (30% mortality rate on average from bone marrow transplants)
3) Genetic Engineering to "block" expression of R5 receptors...... currently underway.  I have a friend who is working on this for Cancer and we've had some interesting conversations I can't repeat.
4) Pharmacological inhibition (drugs).  Selzentry (maraviroc) is currently on the market.  there are two other drugs in trials that I know of, and I think a whole rash of precliinical candidates.  I'm presently in the Phase II naive study for Vicriviroc.  It works, has few side affects, and I'm probably not allowed to say anything else.

aside from what I'm currently taking, I think the drug option is the safest, cheapest, easiest to scale, and makes the most sense.  genetic modification is begging for trouble.  I wouldn't go near that with a 10 foot pole... unless of course you could make me permanently blond, an inch taller, blue eyed, and give me a stunning body.....lol in which case why not add enlarged manhood and show me (and every other guy) where to sign up.

[jkinatl2]

I see this as a gateway to very important resources utilizing genetic research and perhaps to silence those who say that funding for one disease or condition is disproportional. Many things are connected, and though the line from sickle cell anemia, cancer, HIV and other conditions might not be straight, it is drawable. And all of us benefit from advances in science. I am a big fan of both applied and pure science. We should not be so arrogant that we assume we know all there is to know, or that all pathways are straight lines.

BTW, they use ferrets, in science, to test flu vaccines. Ferrets are one of the few non-primates who can get, and give the flu. We find our answers in the least likely of places, sometimes.

/had a hole poked in my bone a few years ago for a medical test
//omfg hurt hurt hurt

[mecch]

Ok, sorry for my repeat, but I have put my "hope stock" in the abyzme wonder cure.  As noted above, bone marrow transplants seems so.... medieval.  "bones"  "marrow"  etc etc.

I love the name, "abzyme" and I just know its going to be like "scrubbing bubbles" with smily faces, eradicating all the hiv, which I'll piss away...

http://news.softpedia.com/news/Researchers-Claim-the-Discovery-of-a-Possible-Cure-for-HIV-91176.shtml

If only...

In the real world i'll take whatever the best science has to offer.  Currently, my HAART.

[michaelman333]

I dont want  to be a stick in the mud, as my mom used to say... but the only issue i see with this article is that it states he is HIV free in the blood

but a large percentage of HIV actually exists within the organs in our body... i have heard that it can be as much as 90%....

So i would like a bit more information on it... but at least it is a push in the right direction ...