Bil Browning

A cure for HIV infection?

Filed By Bil Browning | December 16, 2010 2:00 PM | comments

Filed in: Living
Tags: cure for AIDS, cure for HIV, HIV/AIDS, stem cell transplant

Can it be true? Has a cure for HIV infection been found?

On the heels of World AIDS Day comes a stunning medical breakthrough: Doctors believe an HIV-positive man who underwent a stem cell transplant has been cured as a result of the procedure.

Timothy Ray Brown, also known as the "Berlin Patient," received the transplant in 2007 as part of a lengthy treatment course for leukemia. hivmeds.jpgHis doctors recently published a report in the journal Blood affirming that the results of extensive testing "strongly suggest that cure of HIV infection has been achieved."

Can you imagine a world where HIV drugs aren't needed any longer? So many people have to swallow dozens of pills each day just to stay alive. It almost seems like a daydream, doesn't it?

One of the most beautiful and touching posts we've run on Bilerico was an open thread asking if Projectors knew someone who died of AIDS. The comment thread will bring you to tears. Wouldn't it be absolutely fantastic to put it on the rubbish heap of history and never have to ask the question again?

What do you think? Will this lead to a cure? The scientists seem rather confident if they're publishing the claim in a medical journal.


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I'm not a professional scientist, but I'm very skeptical. I suppose it is possible the stem cell transplant may have strengthened the patient's immune system to the point that it could keep the HIV counts below detectable, but ...

... as I understand, in the course of an infection HIV, which is an RNA virus, or "retrovirus", translates itself into DNA, and the viral DNA gets incorporated into the host's chromosomes.

Different scientists might define a "cure" in different ways -- the virus might be rendered completely dormant, but the viral genetic information itself is probably still there, leaving open the possibility that the virus might re-activate at some future date. I would call that more of a "remission" rather than a "cure".

If one checks [_the original article_] published in the scientific journal Blood, the abstract includes this statement:

... Furthermore, during the process of immune reconstitution, we found evidence for the replacement of long-lived host tissue cells with donor-derived cells indicating that the size of the viral reservoir has been reduced over time. ... [Emphasis mine -- AJ]

Notice the authors used the word reduced and not eliminated.

Even so, transforming an HIV-infected patient to a state where medication is unnecessary would be an enormous achievement, if it could be replicated on a large scale -- and the vast majority of the HIV-infected would be quite happy to leave the debate about whether or not this should be called a "cure" to the doctors and scientists.

From how it's described in articles I've read previously, they had to completely destroy his own CD4 cells as part of the leukaemia treatment before giving him the donor's stem cells - fairly standard for leukaemia as far as I know, but it's implied that doctors would have to do the same to any HIV+ patient who wanted to go through with it since it's the patient's own cells that carry the virus and therefore present the risk. This leaves the patient at increased risk of infection and certain cancers (many of which are also associated with AIDS). These same risks are also associated with the immunosuppressive drugs he used for just over three years afterwards. This will probably limit its use to drug-resistant patients who would otherwise develop full-blown AIDS.

Also, the cost of the treatment is probably very high which would restrict its availability to Europeans, wealthier Americans and others in Western/first-world countries, placing it far out of the reach of a majority of HIV/AIDS sufferers.

Prevention remains more realistic than cure.

I have to agree with general vein of the comments. I'm not sure if I agree with A.J. about the "cure" debate; the study published describes how the donated stem cells lack the receptors needed for HIV replication and, as Tavdy79 pointed out, they'd have to destroy his own CD4 cells with the virus in them to have the transplant in the first place. I suppose you could concede it's more like making him into an asymptomatic carrier with little to no possibility of remission than curing his infection completely. But then there's the fact that his viral reservoir was reduced to the point where it couldn't be detected, so is it possible that the virus was slowly eliminated from his body by the replication of mutated CD4 cells?

Still, I do agree it's a great scientific breakthrough.

And I agree with Tavdy79 that it would be an incredibly expensive procedure, making it unlikely to become widely available for people who either can't get health insurance coverage because of their pre-existing HIV infection or are already up to their neck in medical bills for antiretroviral drugs, medical exams, and the like (to say nothing of people not in first-world nations). And there's also the issue of where the donor stem cells would come from: there's only something like 1% or less of the total world population that has this mutation, so how feasible is it to use this procedure on the much higher percentage of HIV-positive people? Perhaps if we got more funding for stem cell research we would be able to grow these stem cells in a lab, perhaps from donated eggs with the mutation so we could grow embryonic stem cells.... (I digress.)
Basically, it's great if you'll be able to afford it if they make this a treatment option in the future.

And can you imagine people who get this treatment who are no longer symptomatic carriers of HIV but may still be able to transmit it thinking they've been cured? It could be the 1980s all over again. The study says that the viral reservoir was reduced over time, meaning he still had HIV present in his body for a frame of time after this transplant. It's possible he was still infectious during that time.

I agree prevention remains more realistic than cure.

And can you imagine people who get this treatment who are no longer symptomatic carriers of HIV but may still be able to transmit it thinking they've been cured? It could be the 1980s all over again. The study says that the viral reservoir was reduced over time, meaning he still had HIV present in his body for a frame of time after this transplant. It's possible he was still infectious during that time.

Well, I suppose that is theoretically possible but absolutely all of the evidence that we have from the real world -- from mother to child transmission, to discordant couples, to persons on treatment -- shows that transmission does not occur below certain levels of virus in the blood. With the serodiscordant heterosexual couples in Uganda, as long as the viral load was 1500 or less there was no transmission.

The viral load of the "Berlin patient" initially was undetectable with an assay down to 50 copies. I believe they later used even more sensitive research assays and still did not find the virus.

Even so, transforming an HIV-infected patient to a state where medication is unnecessary would be an enormous achievement, if it could be replicated on a large scale -- and the vast majority of the HIV-infected would be quite happy to leave the debate about whether or not this should be called a "cure" to the doctors and scientists.

This isn't going to be the cure. It's too risky of a procedure, the guy only got it because he needed a bone marrow transplant anyway (due to leukemia). As bad as shit like antiretrovirals are, they're less risky than the surgery done in this case.

And, AJ, due to the destruction of the CD4 cells, there wouldn't be any cells with the viral genetic material. Also, they're looking at antibody count for HIV proteins, greatly reduced means it is gone as your body is no longer fighting it, but if it was to reappear, it could (albeit poorly, as this is HIV).

Also, thoughts on the matter from a HIV researcher: From 2008
From a few days ago

Alas; I also remain pessimistic, and for all the reasons as stated above me (quite well) by other commentators. I feel that not enough time has passed to use the intoxicating word 'cure' to describe this patient - yet. And the expense part of the equation makes it entirely unrealistic for a minimum of 10 yrs from now, at best. We have been down this rosey path too many times for me to get too excited about this, sorry to say. But yes, Bil - it's rather sweet to imagine the possibilities. And imagine if it's all true? Among other scenarios; the lucky few who are naturally resistant to HIV? Each drop of their bone marrow would be worth about a million bucks :)

We'll have to wait and see if they can repeat these results with other people to know if there's anything here worth celebrating, but still it's not like everyone will get this treatment even if it does work. This sounds insanely expensive and time-consuming, and not everyone in the world is going to able to afford having their CD4 cells destroyed (thanks, Vene) and then getting injected with stem cells, what with all the drugs and radiation and treatment that would have to go along with it.

I'm always surprised by how much faith people have in some new technology coming along and improving our collective health when we can't even distribute the tech we have now to everyone. Get everyone who's poz on antiretrovirals, distribute condoms, educate everyone on safer sex, and get everyone to come in for regular testing. We're not close to any of those being applied to everyone in the world at risk or living with HIV, so it's hard to imagine a much more expensive procedure being widespread enough to actually eliminate HIV.