For real?
June 6, 2011 12:53 AM   Subscribe

Is AIDS (or HIV) been...cured? What?

I'd appreciate it if SCIENTISTS would weigh in on this, as I'm not sure if what the news is picking up on is legit or not.

The "Berlin" guy had HIV. He was given a bone marrow transplant in 2007. The news is telling me that he received the bone marrow transplant from someone who was resistant to HIV. Apparently 1% of caucasians are resistant.

So now the virus isn't replicating and there are no signs of it.

What? Is this for real?

If it this a REAL solution, or just a very very specific cure. I don't have a background in medicine, but it seems like one would need to be compatible to the 1% resistant caucasians in order to get this done.

I have heard of research being carried out in areas of Africa where they found certain prostitutes being resistant to HIV. So would this apply to people who are eligible (compatible) with those certain people as well?

Or is this like telephone and the last people to hear it are the fourth estate and they're all "cure for cancer, cure for aids, make a brother wanna stay on tour for days..."?

Any scientists willing to weigh in
posted by hal_c_on to Science & Nature (13 answers total) 6 users marked this as a favorite
If it this a REAL solution, or just a very very specific cure?

IANAScientist, but both. It's a real solution for this man, but a very specific one.

Most experts say it is inconceivable Brown's treatment could be a way of curing all patients. The procedure was expensive, complex and risky. To do this in others, exact match donors would have to be found in the tiny proportion of people -- most of them of northern European descent -- who have the mutation that makes them resistant to the virus.

How risky? The bone marrow transplant kills one third of the patients. This solution is feasible only for patients who already have late stage leukemia, making that risk ethical.
posted by lewedswiver at 1:04 AM on June 6, 2011 [5 favorites]

Like I said here, it's a really rough way to cure this disease. It might be a precursor to future therapies, though.
posted by Blazecock Pileon at 3:14 AM on June 6, 2011

This current Phase 1 trial is interesting:

"SB-728-T is a key addition to the toolbox of technologies required to move from the bone marrow transplant setting requiring a donor, to the use of the patient's own cells to replicate the 'functional cure' for HIV-infected patients in which one could create and maintain a reservoir of HIV-resistant immune cells," said Carl June, M.D., Director of Translational Research at the Abramson Family Cancer Research Institute at the University of Pennsylvania School of Medicine and an invited speaker at the conference. "The combination of robust and reproducible manufacturing, engraftment, trafficking, persistence and selective expansion of ZFN-CCR5-modified cells set this product apart from all other HIV therapies tested to date, and is an important step to move from the allogeneic bone marrow transplant setting to the use of the patient's own cells. In particular, the data showing selective expansion and enrichment of SB-728-T in the gut mucosa establishes mechanistic proof of concept that ZFN-CCR5-modified T-cells can constitute a compartment of the immune system that is protected from HIV infection."

But you know, press release, so grain of salt, etc.

posted by j03 at 3:45 AM on June 6, 2011

Not cured but huge strides have been made in treatment and research. Last week's Economist ran a great article about progress thus far.
posted by freya_lamb at 3:52 AM on June 6, 2011

...including work on how 'natural resistance' might be exploited.

Sorry, hit post too soon.
posted by freya_lamb at 3:59 AM on June 6, 2011

Yes, he is probably cured.

I'm not sure, with our current best treatment, HIV is deadly enough to warrant bone marrow transplant as a routine treatment. Hitting someone with enough radiation to knock down their bone marrow, the risk of rejection and the side effects of anti-rejection drugs are pretty big deals and patients being treated this way would often find themselves out of the frying pan and into the fire.

On the other hand, if you are unlucky enough to have HIV and be in need of a bone marrow transplant, and they can find a compatible donor who is HIV immune, it's probably one of those when life gives you lemons kind of situations.
posted by Kid Charlemagne at 5:04 AM on June 6, 2011 [1 favorite]

It is indeed a very specific cure, but it offers an encouraging clue towards finding a general cure. Given how well current AIDS treatments work, a patient with the financial and medical resources to choose between normal treatment and a bone marrow transplant is overwhelmingly likely to choose treatment.

Excellent article about the man, Timothy Brown, as well as the current state of AIDS research, in last week's New York Magazine.
posted by acidic at 5:32 AM on June 6, 2011

I'm currently reading a really excellent book about the history of cancer treatment (The Emperor of All Maladies.) There's a section about the first attempts to combine multiple chemotherapy drugs to cure childhood leukemia. A large proportion of the participants outright died from the toxicity of the treatment. A smaller chunk of them did go into remission, and then a year or two later were found to have developed aggressive untreatable brain cancer *from the treatment* and died very shortly. Three or four children, for no reason anyone ever figured out, went into remission, stayed in remission forever, never got brain cancer, and lived to ripe old ages.

Which is to say that with highly experimental treatments on a small number of patients, finding a "cure" for one or two very specific patients is an awesome indication that you may be on the right track, but you've probably still got years/decades/centuries of work ahead of you before you have anything like a widely usable treatment, much less cure.

I suspect this is very much like that.
posted by Stacey at 6:23 AM on June 6, 2011 [1 favorite]

I am a scientist, specifically a virologist (though I only work with HIV indirectly).

This case is very real but is a highly specific treatment, not necessarily a cure. While it is cool as a proof of concept, I wouldn't say this gives any hope to finding a general cure as you would have to tailor it to every infected individual. It might perhaps be possible some day with some sort of combination of stem cell technology and gene therapy quite a beyond the state both of those areas are at now.

All viruses need something to grab onto the outside of a cell to get it. This is called the viral receptor. In the case of HIV, it usually uses a combination of the proteins CD4 and CCR5 that are present on the outside of certain immune cells; once it interacts with these proteins, it is able to bring about changes that result in its getting inside and infecting the cell. We've known for a while that there are people who have CCR5 mutations that result in HIV being unable to enter their immune cells. In the case of Brown, they used chemotherapy to kill most of his own cells that were capable of being infected by HIV and then replaced them with cells from someone who has a CCR5 mutation that makes them resistant. Thus, Brown now has a population of immune cells that are resistant to HIV infection. Unfortunately, there are many other cells and tissues that are capable of supporting HIV replication, such as tissues in the brain. Brown may still have latent HIV that could resume replication at a later point. While CD4 and CCR5 are the normal receptors for HIV, some strains of HIV are capable of using other receptors - such as CXCR4 - and not only is Brown still susceptible to infection by those strains but he may already harbor one as they arise from normal mutation of CXCR5-tropic strains during the later stages of HIV infection in normal individuals.

Obviously, we cannot go around giving everyone this combination of chemotherapy and bone marrow transplant. For one, you would need to be compatible with the marrow donor and we would need a lot more marrow and these are already huge problems for normal marrow transplant therapies. Also, bone marrow transplants have their own drawbacks and can be risky by themselves.
posted by The Bishop of Turkey at 6:56 AM on June 6, 2011 [6 favorites]

I am an HIV researcher. The Bishop of Turkey has it. TL;DR:

The Berlin patient issue is super cool but not a general cure as you couldn't do this with every HIV infected person.

Point of note, we are doing the study that j03 mentioned. We have hope here too, but way too expensive to be given to everyone with HIV, not to mention, it wouldn't be feasible in rural settings at all. So we're working on solutions. Sometimes you have to go through super unfeasible solutions before you get to something that works for people who have little access to medical care, much less reliable water and food sources.
posted by Sophie1 at 7:15 AM on June 6, 2011

"I have heard of research being carried out in areas of Africa where they found certain prostitutes being resistant to HIV. So would this apply to people who are eligible (compatible) with those certain people as well?"

Regarding these studies, these women essentially had self-vaccinated and were, by continuing to have sex with infected partners, boosting their "vaccinations", however, it was also found that when the "boosting" stopped, the immunity also waned. Obviously, the women were already engaging in sex work and this was an observational study, and wouldn't be ethical to undertake as a clinical trial (exposing people to the virus).

Vaccines for HIV are supremely difficult as the virus mutates so quickly. Not to say it isn't possible, but Margaret Heckler infamously announced a vaccine would happen within 2 years in 1984. Retroviruses are tricky little fuckers and we still have a long way to go. But progress is being made.
posted by Sophie1 at 7:30 AM on June 6, 2011 [1 favorite]

I am a microbiologist, who works with different kinds of viruses, I am not your microbiologist and this is not microbiological advice.

The Bishop of Turkey has it for the most part, it is also important to keep in mind how fantastically diverse HIV has become in the last ~60-90 years. I was at a seminar recently where someone who does work with HIV talked about how there is variation in the HIV within a single human host then then there is in the influenza virus within the global population each season, and you know how much of a pain vaccination for that is.

As we begin to get cures, and there are a bunch of promising strategies in addition to ones which focus on viral invasion, it may only involve cures for specific strains, hopefully adaptable to others but possibly not.
posted by Blasdelb at 11:52 AM on June 6, 2011

Thanks guys for clarifying some of the questions I had on this.

I really appreciate it.
posted by hal_c_on at 4:14 PM on June 11, 2011

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