> The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs.
For a transmissible infectious disease with a reservoir, cure means eradication. These people appear to have one of the following (just my guesses):
1) Early HAART led to selection pressure on HIV in such a way that, for some people, the HIV itself that became embedded in the latent reservoir is defective in some way. Therefore, the reservoir continues to produce HIV particles, but these are relatively ineffective at infecting additional cells.
2) They are supercontrollers via a previously undescribed mechanism (since they were stated not to be classical supercontrollers).
Again, this is complete speculation that would require sequencing and functional studies to investigate, HIV is not my field, etc.
"Asier Sáez-Cirión of the Pasteur Institute's unit for regulation of retroviral infections in Paris analysed 70 people with HIV who had been treated with antiretroviral drugs (ARVs) between 35 days and 10 weeks after infection – much sooner than people are normally treated.
. . . .
"Most of the 70 people relapsed when their treatment was interrupted, with the virus rebounding rapidly to pre-treatment levels. But 14 of them – four women and 10 men – were able to stay off of ARVs without relapsing, having taken the drugs for an average of three years.
. . . .
"On average, the 14 adults have been off medication for seven years. One has gone 10-and-a-half years without drugs. 'It's not eradication, but they can clearly live without pills for a very long period of time,' says Sáez-Cirión."
Any time I hear of someone not finding that an HIV infection turns into an early death after debilitating illness, I'm glad to hear the news. And if some commonality of those patients can be discovered that provides a clue how better to treat other patients, so much the better. But those odds (the majority of the patients who ceased treatment finding their infections rebounding back to acute clinical disease) are still discouraging. For AIDS, an ounce of prevention is still worth a pound of cure. The cases described here sound less like a "cure" than the case of the baby from Mississippi reported earlier, as these patients still have detectable HIV infections, just not infections currently resulting in clinical disease.
"Functionally cured" is the key phrase in that article. They still have the HIV virus. But their immune system keeps it in check.
That last part I don't understand. At that point, isn't it just a fine balance that can tip over at any point in the future, were the virus can come back stronger? Like if the person gets a cold, or the immune system get's weakened somehow (even for just a short time).
I'm guessing the balance isn't that fragile because the people in question have had been drug-free for seven years on average. They must have had some minor illness during that time period.
"Last week, a baby was reported to have been 'functionally cured' of HIV after receiving a three-drug regime of ARVs almost immediately after birth."
I'm curious about the qualifier "functionally cured" and what this means exactly.
The basic idea I gather from the article is that unusually early drug treatments have been found to 'cure' people of HIV in this way, where they no longer need drug treatments.
>The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs.
They still have HIV, and it may develop into AIDS again later. They can also still spread it, since they do have it in their system. They just don't have enough of it to cause them problems.
With the baby there supposedly aren't any traces, but it's perfectly possible that there are still packets of the virus present. There is no definitive way to know the virus is completely gone and won't come back later.
So they feel great, don't need medical treatment, but can still spread it to others... so great, maybe here we go with AIDS becoming as common as the flu (and mutating more, and killing poor people who can't afford the expensive therapies)
Is there a reason why you think that? It will probably still be sexually transmitted (so it can be avoided more easily than the flu), and it already has a much worse impact on poorer communities. Also, you are assuming that the treatment will remain expensive forever and that there won't be any preventative treatments available in the future.
Perhaps he is thinking of Gibsons's Bridge trilogy. There AIDS is cured by finding a variant of HIV which does not cause the disease. And at least in one scene it is implied that infection with the harmless variant is a usual prerequisite for casual sex.
"Curing" is proving a negative, it's hard, especially with a disease that has a long period of dormancy. Saying "they will never develop AIDS through their natural lifetime" would require waiting for a natural lifetime, which is rather a while. But we have a lot of technology that is capable of measuring viral load and so we can say that someone appears to be cured in that they do not show any viral activity over a significant period of time.
Lets use cancer terminology. The people's HIV is in remission. As with cancer, you can treat it to the point that its undetectable by current tests. Since a doctor may not be able to guarantee your cancer has been completely obliterated (all cancerous cells destroyed), you are in remission. I would look at this in the same way.
It means they can't detect any HIV on repeated tests, but they don't know exactly what's going on so they're hedging in case they've overlooked something.
With the baby actually, from the NPR interview I listened to was that medication was given late. The mother did not know she was HIV positive until she was about to deliver so the preventative? medication wasn't given. Following that she was given very high dosage.
That baby may be actually cured because treatment may have started before the virus could establish a reservoir.
The older people have just had their infection knocked down to a very low level. In theory you can be cured if you're treated as soon as you're exposed to the virus, but it's very, very rare that people know they've been exposed.
Well there's a specific reason they don't say you're "cured" of cancer. They use the word remission. Which honestly sounds more appropriate here as well.
It's more than semantics. The reason is that we cannot declare a cure until we fully understand cancer's genesis. And we don't.
> ... but that's not the same thing as saying you can't be cured.
That's exactly what it means -- no one is ever "cured" of cancer. All cancer victims remain at higher recurrence risk than those who have never had cancer.
>That's exactly what it means -- no one is ever "cured" of cancer. All cancer victims remain at higher recurrence risk than those who have never had cancer.
That's simply not true, with one caveat[1]. As a population, of course, it's true. Of course because you can't know whether or not you're cured you can't dismiss the possibility your cancer will return. But that doesn't mean it's actually a possibility in your specific case. If you happen to be one of those lucky people who had a cancer that didn't metastasize, and they got all of it (every last malignant cell), you are not going relapse. There's nothing to relapse.
That's why I say this is semantics. You're talking about what we know and what we have to assume for the purposes of treatment. I'm talking about what is, even if we don't know it.
[1] The caveat being that chemotherapy increases the risk you'll develop a cancer you would not otherwise have developed. But not the same cancer - a new one. So you can't correctly call it a relapse.
> But that doesn't mean it's actually a possibility in your specific case.
We're not discussing whether a particular person -- or any person -- is cured. We're discussing whether we can know this -- you know, like in science? If I say Bigfoot is out there hiding, you may reply, "There's no evidence" and for a scientist with a scientific outlook, that ends the conversation. Only a nonscientist would argue about something that isn't a matter of evidence, of empirical observation.
> That's why I say this is semantics.
It is not semantics, unless you think the fact that Bigfoot's existence cannot be disproven constitutes evidence that it exists.
> I'm talking about what is, even if we don't know it.
Ah -- my apologies -- I didn't realize we were discussion religion. Thanks for the heads-up.
Oncologists don't operate on the basis of faith and belief. That's why (s)he (at least, a professional oncologist) will never say that someone is cured of cancer. Neither will a scientist.
>We're not discussing whether a particular person -- or any person -- is cured.
That's what I was discussing.
>Ah -- my apologies -- I didn't realize we were discussion religion. Thanks for the heads-up.
What an idiotic thing to say. We're not talking about quantum mechanics here. Just because your oncologist doesn't realize you've been cured doesn't mean that's not the case.
>Oncologists don't operate on the basis of faith and belief. That's why (s)he (at least, a professional oncologist) will never say that someone is cured of cancer. Neither will a scientist.
Again, they won't say it because they don't know. Let me break something to you as gently as I can: Just because you don't know something doesn't mean it isn't true. The idea that some number of people are cured of cancer every year isn't controversial at all, even among oncologists and scientists.
> Just because your oncologist doesn't realize you've been cured doesn't mean that's not the case.
You're posing a metaphysical argument. Science is limited to what we can establish with evidence.
> Just because you don't know something doesn't mean it isn't true.
And my describing your argument as religious was idiotic? Check you logic. Asserting the truth of things for which there is no evidence is by definition religious.
> The idea that some number of people are cured of cancer every year isn't controversial at all, even among oncologists and scientists.
Absolute nonsense. Scientists require evidence, and there is no evidence. The reason? We don't understand cancer. Even a person who dies 50 years later of unrelated causes after having had cancer is still officially in remission.
To claim a cure, we would need to know the cause to which the cure applies. Then we would need to prove the cure worked. We don't know these things about cancer -- out methods treat symptoms, not causes.
Your claim is like playing Russian Roulette while claiming the gun is actually unloaded -- until it turns out not to be. It's not science, it not evidence, it's superstition.
Apropos, a cancer treatment center was recently taken to task for claiming a higher success rate than their competitors, on the ground that they were only accepting younger, healthier people, so their claims were tainted by sampling error -- but the reason for the debate was not because that center didn't produce cures (no one can do that), but that they they were making remission claims on slippery grounds.
Reading your posts, I see you just don't get science, and modern medicine is evidence-based, i.e. as scientific as possible. This is why oncologists don't commit professional suicide by claiming that anyone is ever cured of cancer.
"So can we ever really talk about a cancer cure? In general, the answer is no."
"When talking to your doctor about your prognosis (the course and outcome of your disease), be sure to find out exactly what he/she is talking about. If they use the term cure, ask if they really mean remission. If they use the term remission, ask if it’s complete or partial. And if they do talk about remission, ask about the rates at 5, 10 or 20 years. This will help give you an idea of the odds of cancer recurrence within your lifetime."
>To claim a cure, we would need to know the cause to which the cure applies. Then we would need to prove the cure worked. We don't know these things about cancer -- out methods treat symptoms, not causes.
Oh? We're treating symptoms? So your contention is if I remove (by some artifice) every cancer cell from someone's body they may still relapse? Really? That's an extraordinary claim for which I have a hard time believing you'd find any support at all in the medical community.
You're still evading the point. What the oncologist tells a particular person about his prognosis is completely irrelevant to my point.
Let me set up a thought experiment for you. Let's say I have three cups an some number of balls between zero and three. When your back is turned I may or may not put a ball under any or all of the cups. Then you turn back around.
Of course you don't know if the cups have balls under them. Your argument is because you don't know whether or not a cup has a ball under it, then it doesn't. I assert that a cup can have a ball under it even if you don't know the ball is there, and you claim I've invented a religion.
> So your contention is if I remove (by some artifice) every cancer cell from someone's body they may still relapse?
Yes, if the person has a predisposition to cancer. The evidence? They got cancer in the first place. The counterargument would have to be that they were born with cancerous cells in place, waiting to be activated. But if cancer doesn't depend on cells, but a genetic factor, then yes -- even if you remove every cancerous cell, the person can relapse. And there is plenty of evidence for genetic factors. I emphasize this doesn't mean we know which factors, or how they work, only that we can see a correlation with genetics.
And correlations without known cause-effect relationships make poor science.
> That's an extraordinary claim for which I have a hard time believing you'd find any support at all in the medical community.
You aren't bothering to read what I've posted. Shall I post more quotes that prove my point, or are you willing to learn this topic on your own?
"Cancer patients often mistake cancer remission as a cure, but this is not so. Remission is the period of time when the treatment is effective and the cancer is under control. There are two types of remission--partial and complete. The time frame can vary from weeks to even years, depending on the type of treatment and the stage of the cancer."
"The whole “never being cured” thing is tough to swallow when you’re first diagnosed ... Sure, we may have to take these medicines for the rest of our lives, but if they’re keeping us alive and not harming us, who cares?"
>Yes, if the person has a predisposition to cancer. The evidence? They got cancer in the first place.
It's odd you can make that assumption and then breezily mention the correlation/causality problem in the very next paragraph. Just because a person gets cancer there's not necessarily any reason to believe they're predisposed to it. We know a wide range of environmental factors cause genetic damage.
>You aren't bothering to read what I've posted.
I can tell based on the snippets you're posting they're not relevant to the conversation. You keep making the same tangential point over and over. Yes, okay, I understand an oncologist won't ever tell you your cancer is cured.
> You keep making the same tangential point over and over.
So the scientific standing of cancer research is "tangential"? Your claim has been that scientists know that people are sometimes cured of cancer. This is false -- only religious zealots believe that. Scientists know better.
> Just because a person gets cancer there's not necessarily any reason to believe they're predisposed to it.
Dubious for an individual, true for a population. But I can see there's no point to this -- you don't have the required scientific background or appreciation for statistics.
Yeah, but cancer is not infectious. People will always develop cancer, but we could potentially get to a point where nobody has HIV anymore, if we can prevent the virus from spreading.
Not disagreeing with you since as far as I know, there are no human cancers that are contagious. There are at least 2 mammalian cancers I know of, and possibly more, that are contagious. One is a disease wiping out Tasmanian devils. Another is a sexually transmitted cancer among dogs. Its thousands of years old and shows up as small tumors around the genital regions of affected animals. There was a TED talk describing this in some detail. Don't have the time to search for a link at the moment, but you can probably find it.
Heh--according to the article, there are 3 transmissible cancers, and you named 2 of them. ... Wow, I find this kind of astonishing.
The tumor cells are themselves the infectious agents, and the tumors that form are not genetically related to the host dog. Although the genome of CTVT is derived from a canid (probably a dog, wolf or coyote), it is now essentially living as a unicellular, asexually reproducing (but sexually transmitted) pathogen. Sequence analysis of the genome suggests it diverged from canids over 6,000 years ago; possibly much earlier. However, the most recent common ancestor of extant tumors is more recent: it probably originated 200 to 2,500 years ago.
The specific thing about HIV is that it's an STD. You can still give it to other people, so it's not 100% safe to continue life as you had before. If you're having sex, it can't be unprotected, even with your significant other. If you're bleeding, you still need to cover the wound as absolutely fast as possible so other people don't get one of the terrors of our lifetime.
You're not cured, you're just protected. Cured would mean there was no chance of you sharing HIV with someone else afterward. The terror of HIV suggests, to me, a different term to use.
This caused me to look up the Timothy Brown case, the man who was cured of AIDS via a bone marrow transplant for his leukemia with cells from a supercontroller. I get the concept of remission for the patients in the New Scientist article, but this article has Brown claiming he's completely cured:
This is quite an achievement to go from no cure whatsoever, to a cure that works on 1% of people. Because now you don't need to look for things that works, you need to improve something you have.
> The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs.
For a transmissible infectious disease with a reservoir, cure means eradication. These people appear to have one of the following (just my guesses):
1) Early HAART led to selection pressure on HIV in such a way that, for some people, the HIV itself that became embedded in the latent reservoir is defective in some way. Therefore, the reservoir continues to produce HIV particles, but these are relatively ineffective at infecting additional cells.
2) They are supercontrollers via a previously undescribed mechanism (since they were stated not to be classical supercontrollers).
Again, this is complete speculation that would require sequencing and functional studies to investigate, HIV is not my field, etc.