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Medicine

'Boston Patients' Still HIV Free After Quitting Antiretroviral Meds 117

Posted by Unknown Lamer
from the 90s-dream-come-true dept.
ananyo writes "Two men with HIV may have been cured after they received stem-cell transplants to treat the blood cancer lymphoma, their doctors announced today at the International AIDS Society Conference in Kuala Lumpur. One of the men received stem-cell transplants to replace his blood-cell-producing bone marrow about three years ago, and the other five years ago. Their regimens were similar to one used on Timothy Ray Brown, the 'Berlin patient' who has been living HIV-free for six years and is the only adult to have been declared cured of HIV. Last July, doctors announced that the two men — the 'Boston patients' — appeared to be living without detectable levels of HIV in their blood, but they were still taking antiretroviral medications at that time." The story reports that they have only been off of medication for seven and fifteen weeks and they won't know for a year, but signs are looking positive.
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'Boston Patients' Still HIV Free After Quitting Antiretroviral Meds

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  • by Andrio (2580551) on Wednesday July 03, 2013 @09:39AM (#44175685)
    The only real cure we have for this disease.
    • Re: (Score:3, Funny)

      by Penguinisto (415985)

      Actually, it wasn't Magic Johnson, but his massive pile of cash [wikia.com].

  • Hey! (Score:5, Funny)

    by Anonymous Coward on Wednesday July 03, 2013 @09:39AM (#44175687)

    The story reports that they have only been off of medication for seven and fifteen weeks and they won't know for a year, but signs are looking positive.

    Phrasing >=(

  • by Anonymous Coward on Wednesday July 03, 2013 @09:43AM (#44175731)

    surely, signs are looking negative?

  • I remember recently there was some talk about research into curing some cancers by removing the patient's bone marrow, using HIV (ironically) to modify it, then transplanting that bone marrow back to the patient. What are the chances that something similar could be done here? To me it seems like all the pieces are in place; we know which gene confers some immunity, we are capable of editing targeted genes, and we can perform the bone marrow transplant. A marrow transplant would still be dangerous, but al

  • by SuricouRaven (1897204) on Wednesday July 03, 2013 @09:47AM (#44175795)

    There's a good chance this 'cure' will kill the patent. It works, but it's dangerous. The choice is between a treatment that may kill you now, or a disease that will kill you eventually. And either way you'll get to take lots and lots of drugs with nasty side effects.

    • by ddq (2421932) on Wednesday July 03, 2013 @10:05AM (#44176033)
      Life tends to kill you eventually.
      • What's the insightful point here? This sentiment has been historically been raised in conversations about HIV as an excuse to not care about a disease that primarily affects homosexuals. It's far rarer that people say "Oh, well everyone has to go sometime" when discussing cancer research. So apologies if you're not being callous towards homosexuals with HIV, and are instead just making a trite observation that everyone dies.
        • by ddq (2421932)
          Worldwide, HIV affects far more heterosexuals. While in developed countries, it is proportionally higher in homosexual men, almost 70% of people with HIV live in Sub-Saharan Africa. So if anything, I was being racist, not homophobic. (In reality, I was being neither, instead merely trite.)
        • by Rockoon (1252108)

          It's far rarer that people say "Oh, well everyone has to go sometime" when discussing cancer research

          But more people should. When you consider how much money has been thrown at cancer and how little progress has actually been made (early detection is many times more important than any of the "advances" that have been made,) one has to wonder exactly how many ways that money could have been used to do some real good.

          Here is physicist Paul Davies that has looked into cancer research. [youtube.com] $100 billion in research just in the United States since Nixon declared war on it. Eye opener at 5:30.

    • by SirGarlon (845873) on Wednesday July 03, 2013 @10:13AM (#44176105)
      Unless I'm mistaken, that's what they used to say about chemotherapy. Finding ways to help patients survive the therapy may be an easier problem than finding ways to help them survive the disease.
      • by MozeeToby (1163751) on Wednesday July 03, 2013 @11:15AM (#44176893)

        Marrow transplants are dangerous, and there's no obvious way to go about making them safer. The problems are a fundamental result of the procedure itself, not simply a side effect. First, you must kill off the patient's bone marrow, there's simply no way around it since the bone marrow is what is causing the problem you are trying to treat. The only ways we know how to do that are with near fatal doses of chemotherapy or radiation. Actually, the doses are fatal, if they do what they are supposed to do and the patient doesn't receive their transplant they will die (when you donate there is a time period after the patient has had their marrow destroyed but before you actually donate, if you change your mind and decide not to donate during that time period the patient will almost certainly die unless another donor can be found and medically cleared in a matter of days). Then there's a period of not days, but weeks where the patient has no functioning immune system to speak of, not to mention severely limited red blood cell production. Then there's graft vs host disease where the immune system rejects it's new host body, essentially like organ rejection except in this case it affects the entire body. Then there's liver and kidney damage (both from the chemo and/or radiation and as a result of the transplant itself) and increased risk of cancer (not related to the original cancer being treated).

        And that's all assuming that a suitable match can be found, which isn't guaranteed. A non-ideal donor increases the risk of complications, especially graft vs host (but can actually reduce the risk of cancer relapse interestingly). Part of the reason a donor can't always be found is that there simply aren't enough people on the registry, largely because people have this notion that donation is an extremely painful process. This was true in the past, but most donors now donate peripheral stem cells, where a drug (filgrastim) is given for a few days and donation is done through vein in the arm.

        • by omnichad (1198475)

          And why can't the patient be their own stem cell donor? Aside from re-inheriting their propensity for marrow cancer?

          • by sjames (1099)

            The stem cells are what malfunctioned in the patient. You'd be putting the cancer back in them.

            • by omnichad (1198475)

              I'll admit to not knowing much about every cancer, but would it really affect every cell in the body simultaneously or would there be a pocket of good cells somewhere?

              • by sjames (1099)

                In the case of a cancer where marrow transplant is curative, there would be no way to be sure, but it will tend to be everywhere.

                Note that this is distinct from stem cell rescue where the patient receives a drastic treatment for a non-marrow cancer that would destroy their marrow as a secondary effect. In those cases, they do donate stem cells to themselves.

        • by nbauman (624611)

          Another reason why donors can't be found is that during the genetic construction of HLA DNA, there is so much diversity that, if a sibling isn't available, your chances of finding a match are remote.

        • Marrow transplants are dangerous, and there's no obvious way to go about making them safer. The problems are a fundamental result of the procedure itself, not simply a side effect. First, you must kill off the patient's bone marrow, there's simply no way around it since the bone marrow is what is causing the problem you are trying to treat. The only ways we know how to do that are with near fatal doses of chemotherapy or radiation. Actually, the doses are fatal, if they do what they are supposed to do and the patient doesn't receive their transplant they will die (when you donate there is a time period after the patient has had their marrow destroyed but before you actually donate, if you change your mind and decide not to donate during that time period the patient will almost certainly die unless another donor can be found and medically cleared in a matter of days). Then there's a period of not days, but weeks where the patient has no functioning immune system to speak of, not to mention severely limited red blood cell production. Then there's graft vs host disease where the immune system rejects it's new host body, essentially like organ rejection except in this case it affects the entire body. Then there's liver and kidney damage (both from the chemo and/or radiation and as a result of the transplant itself) and increased risk of cancer (not related to the original cancer being treated).

          And that's all assuming that a suitable match can be found, which isn't guaranteed. A non-ideal donor increases the risk of complications, especially graft vs host (but can actually reduce the risk of cancer relapse interestingly). Part of the reason a donor can't always be found is that there simply aren't enough people on the registry, largely because people have this notion that donation is an extremely painful process. This was true in the past, but most donors now donate peripheral stem cells, where a drug (filgrastim) is given for a few days and donation is done through vein in the arm.

          My brother-in-law is going through this right now, except he is acting as his own donor. They extracted some of his stem cells before the procedure, and have re-implanted them. He's in the immune system rebuild phase now.

        • by CrimsonAvenger (580665) on Wednesday July 03, 2013 @01:20PM (#44178721)

          (when you donate there is a time period after the patient has had their marrow destroyed but before you actually donate, if you change your mind and decide not to donate during that time period the patient will almost certainly die unless another donor can be found and medically cleared in a matter of days)

          Umm, no.

          Had this done last fall.

          The Donor was donating before they started the chemotherapy on me. Until he'd provided enough stem cells, I just lay in the hospital bed getting nothing at all done....

      • Unless I'm mistaken, that's what they used to say about chemotherapy.

        They still do. Chemotherapy is quite dangerous and even in the best cases is pretty brutal on the patient. I've had the misfortune to see several people close to me go through chemo and it is an awful treatment with no guarantee of success. In some cases the chemo itself can be lethal.

    • Re: (Score:2, Insightful)

      by Anonymous Coward

      This isn't a cure for the desease, this is two instances of people being cured, which could potentially lead to a cure without serious side effects (othat than those of genetic manipulation).

    • by drinkypoo (153816)

      Before the invention of the rat bastards at the AMA, it was said that with allopathic medicine you died of the cure, while with naturopathic medicine you died of the disease. IOW this has been a known quandary in medicine since long before you noticed. Cutting out a cancer might kill a patient, or they might live out the rest of a nice lifespan. Etc.

      • by ArsonSmith (13997)

        What! You mean people have to way risks? This is terrible the government should step in and decide what to do.

        • by zennyboy (1002544)

          *weigh?

        • by Sarten-X (1102295)

          Yes it should, because people are utterly terrible at weighing risks for themselves.

          • Look, it's our old friend Tyranny, dressed in "I am better able to judge than you" clothes this time.
            • by Sarten-X (1102295)

              Looks like the same old garb to me. Dictators, monarchs, and bureaucrats have always promoted themselves as making better decisions for the good of their people. The key lies in the definition of "better". Tyrants adopt a policy that benefits themselves most, when what's needed is a policy that benefits everyone.

              The existence of faults in a government does not mean it's worse than letting each person make indepentently bad decisions.

    • There's a good chance this 'cure' will kill the patent. It works, but it's dangerous. The choice is between a treatment that may kill you now, or a disease that will kill you eventually

      It's a bit more complex than that, according to the article:

      1. "The finding is very important for people with HIV who also need blood-cell transplants, but the treatment is unlikely to be used more generally because the risks from [allogeneic] transplants are high."
      2. "Their doctors think that an immune response called graft-versus-host disease — a post-transplant reaction in which donated cells kill off a patient’s own cells — may have then wiped out the patients’ HIV reservoirs, po

    • by evilRhino (638506)
      Yes, the mortality rate for stem-cell transplants is improving, but it is still not zero. I believe the rate was ~20% in 2009. http://www.sciencedaily.com/releases/2013/05/130528180857.htm [sciencedaily.com]
    • by sjames (1099)

      Of course, they needed the transplant anyway for lymphoma which would certainly have killed them faster than the HIV. getting cured of HIV is a pretty nice consolation prize.

  • "signs are looking positive."

    I hope not. Wouldn't that rather spoil the point?

  • I wonder when some church is going to claim their did it.
    And another will claim these people are no longer human.

    • Re: (Score:2, Offtopic)

      by drinkypoo (153816)

      I wonder when some church is going to claim their did it.
      And another will claim these people are no longer human.

      Well, on the plus side, if it makes you not human, then the bible doesn't apply to you as you're no longer one of god's creatures. Cavort!

  • Are these the same stem cells that the Christian Right was trying to ban for research?

    • Re:Stem cells (Score:5, Informative)

      by Petron (1771156) on Wednesday July 03, 2013 @11:06AM (#44176781)

      Appears to come from modifying adult blood-forming stem cells. Adult stem cells have little to no controversy.

    • by Chrisq (894406)

      Are these the same stem cells that the Christian Right was trying to ban for research?

      Not that I approve of the Christian Right, but I don't think so. These are bone marrow transplants that give blood stem cells from an adult donor. I think that the Christian Right are only against embryonic stem cell research

      • by Petron (1771156)

        Yes, the thing that comes to mind is: Would a doctor encourage abortion more if they can harvest embryonic stems cells... or would they fertilize eggs and have them grow in the lab to be harvested later. If you view life beginning at conception (which many people do, not just Christians), this would be a huge ethically questionable act.

        • by sjames (1099)

          So would IVF. Most of those eggs don't get implanted. They either go in the incinerator or get frozen indefinitely.

    • by the gnat (153162)

      No, these are transplants from bone marrow donors - no embryos or cloning involved.

    • No, the ones they are trying to ban come from killing humans while they are in their fetal or embryonic stage.
  • The previous "cure" was following a bone marrow transplant from someone with a mutation that made them highly resistant to HIV [nature.com]. This article makes it sound as though it was the transplant itself that cured the HIV. Does anyone know if these transplants also involved a resistant donor?
  • HIV levels go to undetectable in many HIV-drug patients, then reappear once off the drugs even if they have taken them over a decade. It was postulated there was a mystery resevoir for the virus. And/or it integrated into the victims DNA.
  • "but signs are looking positive" I think they mean signs are looking negative, lol.
  • We're HIV Positive

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