Spanish Doctors 'cure' HIV patient with umbilical cord blood transplant...

[Tadeys]

A 37-year-old man from Barcelona, who had been infected with the HIV virus in 2009, was cured of the condition after receiving a transplant of blood from such an umbilical cord.




http://www.thelocal.es/20141106/doctors-cure-hiv-patient-with-blood-transplant

[Buckmark]

This doesn't sound so different from the case of Timothy Brown ("The Berlin Patient").  One had leukemia, this guy had lymphoma.  The point of both patient's procedures was to replace their blood stem cells.  The source of those stem cells can be umbilical cord blood, or bone marrow, or donor blood.  The rest of the procedure is quite the same:  destroy the host's current bone marrow (where blood stem cells are made), and replace it with the source of new stem cells from the donor.  Most "bone marrow transplants" these days don't actually involve bone marrow as the source of stem cells, but either umbilical cord blood or adult peripheral blood (essentially plan old circulating blood).  "Stem cell transplant" is the customary term these days.

Having lymphoma myself, I have (and still might) face the possibility of a stem cell transplant.  Believe me, if I were to face that, I have also thought about asking about the possibility of a donor with the CCR5 delta 35 mutation.  But having lymphoma myself, I've connected with many people who have had a stem cell transplant, and it is unpleasant -- to say the least.  It is expensive.  It takes years to recover from it.

At best, this is a cure for HIV+ individuals who have another disease requiring treatment with a stem cell transplant (leukemia, lymphoma, etc.).  *If* the appropriate and matching donor who also has the CCR5 mutation can be found, which cannot be guaranteed.  But this will never be a mainstream treatment for HIV.  And, speaking from experience, you don't want one of those diseases requiring a stem cell transplant.  As noted in the article, the Barcelona patient ultimately died.

All this said, it is notable that they are doing a clinical trial for HIV patients with blood cancers.  Unfortunately, I don't see any link to that trial in this article.

Regards,

Henry

[buginme2]

There are clinical trials currently under way in hiv+ patients with lymphoma or leukemia at the Fred Hutchinson cancer research center.  You can read the description of the trials online but they don't sound fun at all.  In many cases they require whole body radiation, chemo, and then a stem cell transplant. 

I'm really amazed that this is actually a serious research area.

[Buckmark]

There are clinical trials currently under way in hiv+ patients with lymphoma or leukemia at the Fred Hutchinson cancer research center.  You can read the description of the trials online but they don't sound fun at all.  In many cases they require whole body radiation, chemo, and then a stem cell transplant. 

I'm really amazed that this is actually a serious research area.

I did find a link for the trial at Fred Hutchinson:  http://www.cancer.gov/clinicaltrials/search/view?cdrid=654365&version=HealthProfessional

There are so many inclusion / exclusion criteria that I wonder how many participants they are actually getting.  First, you have to be HIV+.  Second, you have to have a blood cancer.  Third, your primary cancer treatment must successfully get you into remission, and then you have to relapse (i.e. "beyond first remission").  Fourth, you would ideally want to get a donor with the CCR5 mutation, in addition to all the other donor matching criteria stated -- but that doesn't seem to be required to participate. 

I wonder what, if any, costs they cover under this trial?  It would be impossibly expensive for them to cover the cost of all the participants'  stem cell transplants.

[buginme2]

Thats a really good point.  Insurance companies dont pay if the treatment is experimental.  I had a friend find that out the hard way.

The Fred Hutch did get a $10million grant from the NIH to find a cure for HIV using stem cell transplants so hopefully that money is used to cover the cost to the patient.  I would assume so but ya never know.

Right now I dont know if their trials include modifying the ccr5 gene or not.  I think they are going to be using the Sangamo magic fingers thing to knock out the ccr5 in trials starting next year. 

I went to a presentation by the researchers on this trial and it was interesting hearing them talk about the research they are doing.  They dont know what cured Timothy Brown.  Its speculated that the donor who had the ccr5 gene is what cured him but technically they dont know.  It could be something else specific to the stem cell transfer, the radiation, the types of drugs he received, or something else.  They have now and will have even more trials where they change just one aspect to see if they can measure what effects latent viral loads and what doesnt.  Its pretty interesting but also very daunting. 

Ive posted their link before but they have a pretty neat website at

www.defeathiv.org

[Buckmark]

The Fred Hutch did get a $10million grant from the NIH to find a cure for HIV using stem cell transplants so hopefully that money is used to cover the cost to the patient.  I would assume so but ya never know.

Sadly, $10 million does not cover very many stem cell transplants   And even then, all of the grant money doesn't go to the cost of the transplant.

They dont know what cured Timothy Brown.  Its speculated that the donor who had the ccr5 gene is what cured him but technically they dont know.  It could be something else specific to the stem cell transfer, the radiation, the types of drugs he received, or something else.

Seems like they should be able to go back and look at previous HIV+ folks who had stem cell transplants, and evaluate the treatments they had.  We haven't heard of anyone else being "cured" of HIV from a stem cell transplants.  It's hard for me to believe that chemo or radiation managed to eradicate the HIV virus, as it is hard enough for these treatment to kill cancer cells, let alone a pervasive and fast-replicating virus.  But it is not known if Timothy Brown's experience is repeatable and I suppose that is what they want to study.  I think it's going to be a loooong study.