Is Bone Marrow Transplant Enough to Cure HIV?

[geobee]

This is an interesting article about 2 men who are positive, then both received bone marrow transplants for lymphoma.  The donors were NOT of the 1% CCR5 negative population (like the donor for Timothy Ray Brown).  The 2 were on ARVs the entire time before and after the transplant.  I don't think they were UD, which explains the following line:

"The first man’s viral-DNA levels began to decline 70 days after his transplant and were undetectable at 200 days. The levels fell more slowly in the second man and could no longer be detected by Day 300. The samples also were checked by Michael Busch, director of Blood Systems Research Institute in San Francisco, who told me his tests “support the hypothesis that these patients may have eradicated the virus.”

So the docs are going to withdraw ARVs and see if they are, in fact, cured.  If they are, well, WOW!  Second a BMT is not for the faint of heart, not widely accessible, high mortality rate, etc.  But it would certainly point the way to stem cell treatments as a possible cure.

Here's the article --
http://www.forbes.com/sites/robwaters/2012/07/26/possible-cure-in-two-more-aids-patients-as-research-momentum-grows/

[geobee]

Hmmm... the story just got a little more complicated.

http://www.msnbc.msn.com/id/48338421/ns/health-mens_health/#.UBGl0bTy8sI

This reporter says the two men had a "genetic mutation" -- perhaps they were heterozygotes? 

"The findings may not apply to all patients. Both men were a little unusual in that they had a genetic mutation that can make immune cells resistant to infection by HIV. Their new immune cells, however, which came from the donors, are fully susceptible to the virus."

Another article:
http://abcnews.go.com/blogs/health/2012/07/26/two-more-patients-hiv-free-after-bone-marrow-transplants/

[geobee]

OK, last one! 

In this link they hypothesize that graft vs. host disease of the new bone marrow may be killing of the old bone marrow.  And that because they were given a small dose of chemo during the transplant, they were able to stay on their ARVs the entire time.  No mention of them being heterozygotes.

http://www.npr.org/blogs/health/2012/07/26/157444649/two-more-nearing-aids-cure-after-bone-marrow-transplants-doctors-say

OK, just going to put it out there.  If this works...and a bone marrow transplant costs, what, 100K? ...

[Dr.Strangelove]

I really really want to get rid of that virus but even if I could afford a bone marrow transplant - I'll pass on this one. Going to wait for something better, less invasive to come out.

But besides that, I don't trust news articles too much. I'm looking forward for the scientific publication of this case to come out. Might take a while though.

[leatherman]

bone marrow transplant costs, what, 100K? ...

there's still all the side effects/after effects to consider, not to mention the increase in the risk of death by the procedure itself, throughout the process, and for several yrs.

besides, I keep wondering if having the lymphoma is a factor toward this kind of "cure" working. Until this sort of process is "tested" on someone without the issues that brought on the lymphoma in the first place, I don't how they can know whether and how the lymphoma factors into the situation. Also isn't part of the procedure based on resolving the lymphoma issue? Without the cancer how would they determine how much chemo etc to put you through to reach this "cure"?

These people probably would have never gone through this procedure except their risk of death from the lymphoma and HIV outweighed their risk of death from the transplant. at this point in my life, although that dollar figure may be less than paying for another x amount of yrs of medication for me, getting a bone marrow transplant would actually raise my risk of dying and risk destroying my quality of life and that's not worth the risk to me. My haart regime isn't that bad.

[Common_ground]

Sure I also would like to be HIV free but not at any price. I would only consider a high risk procedure like bone marrow transplant when and if the odds tip over.
With the amount of partying after being HIV free I might even live longer and healthier on the meds  and with HIV:)

[Jake2011]

Had a quick skimm over this, there does seem to be a fair bit of coverage of this in the media..!

Could someone please clarify this though, are we saying;

•   That these two guys have possibly been cured (which can only be verified once they stop taking ART) by having a bone marrow transplant whilst continuing their Hiv treatment (i.e. continuing treatment before, during & after the bone marrow transplantation) and that the bone marrow donor did not carry the two copies of the defected CCR5 gene. 

In conclusion this would mean that Hiv (potentially) could be eradicated simply through bone marrow transplantation & ART?

[leatherman]

could be eradicated simply through bone marrow transplantation & ART?

although there's nothing "simple" about a BMT and it's consequences, yes, they are implying these guys may no longer have HIV

[jkinatl2]

At the current state of treatment, doesn't a bone marrow transplant offer a far greater risk of death than HIV?

[Jake2011]

although there's nothing "simple" about a BMT and it's consequences, yes, they are implying these guys may no longer have HIV

Leathermen....for sure, but surly it would be a step in the right direction / an improvement on where we are at the moment. Cutting out the need to find a donor with the CCR5 defective gene surly would be a good thing, it would simplify the Bone Marrow Hiv eradication process.

The Timothy Brown bone marrow transplantation process is hard but this new method would make it a whole lot easier.

[mecch]

perhaps they were heterozygotes? 

What on earth is that?  A person can be a "heterozygote"?  Can this homo be one? I want to be one! Is it like being a metrosexual?

[Newguy]

What on earth is that?  A person can be a "heterozygote"?  Can this homo be one? I want to be one! Is it like being a metrosexual?

Hi Mecch

Heterozygote is a term used in genetics to describe the gene inherited by each individual from its parent. For example, since humans inherit one set of genes from their mother and the other set from their father we have two copies of each gene. These are also referred to as alleles, or alternative forms of the gene. A heterozygote is an individual who has different copies of a specific gene. A homozygote is an individual who has the same copy of a specific gene.

Regarding the CCR5 receptor (which is a protein encoded by a gene in the DNA) a person can be heterozygote for this gene or homozygote. If they are heterozygote that means they inherited two different copies from their parents. One functional and one that is not functional. If they are homozygote for the gene, this means they either inherited two functional copies or two non-functional copies.

I hope this helps, that is my quick attempt at a brief genetics lesson.

[Dr.Strangelove]

@Newguy
I suspect this was just a taste of Mecch's sense of humor. Have you been drinking again? 

[Newguy]

I suspect this was just a taste of Mecch's sense of humor. Have you been drinking again?

Oops!

[jkinatl2]

Leathermen....for sure, but surly it would be a step in the right direction / an improvement on where we are at the moment.

 I firmly disagree. An intensely high morbidity rate for BMT forbids that.

HIV, in developed countries with full access to healthcare, is perfectly manageable. You'd rather die than take a pill or three every day?

I just don't get this. Educate me.

[geobee]

I sure wouldn't do a BMT today. But I wouldn't have flown in early airplanes and now they are safe, cheap and reliable.  Perhaps BMT's will get safe and cheap one day too. 

Also, if they are cured, then TRB is no longer some kind of irrelevant outlier.  (Many scientists, after all, pooh-poohed the news that TRB was cured for several years. Ah, the irony!)  Having two others cured will be huge.  We'll know we can cure HIV, and know how to do it.  This will keep the money flowing into cure research, and into T-Cell / stem cell centered cures.  All good.

[jkinatl2]

I sure wouldn't do a BMT today. But I wouldn't have flown in early airplanes and now they are safe, cheap and reliable.  Perhaps BMT's will get safe and cheap one day too. 

Also, if they are cured, then TRB is no longer some kind of irrelevant outlier.  (Many scientists, after all, pooh-poohed the news that TRB was cured for several years. Ah, the irony!)  Having two others cured will be huge.  We'll know we can cure HIV, and know how to do it.  This will keep the money flowing into cure research, and into T-Cell / stem cell centered cures.  All good.

Sigh. PLEASE educate yourself about what's involved in a BMT and educate us as to how an when it will become preferable to ART treatment for HIV.

[mecch]

Re: Is Bone Marrow Transplant Enough to Cure HIV?

Answer:  It is "too much".  Much more than "enough".

[leatherman]

(Many scientists, after all, pooh-poohed the news that TRB was cured for several years. Ah, the irony!)  Having two others cured will be huge.  We'll know we can cure HIV, and know how to do it.

For me, I still don't consider the word "cure" to be the correct way to define the situation for these three men. First off it's the wrong word to use in the public media (giving false hope and distracting the general public from a still serious problem) and secondly it seems scientifically inexact. Their HIV was not "cured" but "eradicated" - a much more extreme approach.  Wiping out someone's complete immune system (which is always going to risk someone's long-term health and/or very life) and replacing it or rebuilding it from the ground up is much difference (a lot harsher, a lot more difficult, with a lot more risks) than simply flushing the HIV from the reservoirs and letting ARVs do the rest.

[geobee]

Hey jkinatl2 -- Here's a good link re: BMTs and what's involved:

http://www.cancer.gov/cancertopics/factsheet/Therapy/bone-marrow-transplant

I've seen two types of language used when talking about a cure -- "sterlizing" and "functional".  These seem like useful ways of describing more and less radical approaches. 

Seem like it a bit of leap to me to say these men may be cured when they are still on their ARVs. 

I thought Tim Horn's article was a good one.
http://www.aidsmeds.com/articles/hiv_cure_transplants_1667_22747.shtml