
Two More Patients HIV-Free After Bone Marrow Transplants - ot
http://abcnews.go.com/blogs/health/2012/07/26/two-more-patients-hiv-free-after-bone-marrow-transplants/
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tokenadult
I have been part of the United States National Marrow Donor Program

<http://marrow.org/Home.aspx>

for more than twenty years. Joining the program involves (or used to involve)
an initial tissue typing, grouping would-be donors into broad categories of
immunologically compatible people. A few years after I joined, when I had
moved to another state, I was called up for second-stage testing to see if my
antigens were a more specific match for some patient who needed marrow on that
occasion. Evidently I was not a close enough match, as I was not asked then to
donate marrow. Now my more specific antigen type is on file, and in all the
almost two decades since then, I never have any contact with the program
except periodic reminders to update the program with my address changes (as I
do) and to tell my friends to sign up (as I also do).

<http://marrow.org/Join/Join_the_Registry.aspx>

What this illustrates is that marrow donations are based on very close antigen
matches, and the human leukocyte antigen (HLA) typing used for those matches

[http://marrow.org/Patient/Transplant_Process/Search_Process/...](http://marrow.org/Patient/Transplant_Process/Search_Process/HLA_Matching__Finding_the_Best_Donor_or_Cord_Blood_Unit.aspx)

divides humankind into so many small categories that it is difficult for most
patients to find a match when they need bone marrow. That, and the
considerable expense of harvesting bone marrow from living donors and
administering bone marrow to patients in need, keeps marrow donations from
being a miracle cure for most diseases. If you join the donor program, as I
encourage you to do, you might reach the age of ineligibility for donation
(currently age sixty) without ever being called up to donate. That appears to
be more likely than not.

A tiny number of cases of a dread disease having patients who "spontaneously"
(that is, through mechanisms not fully understood) go into long-term remission
from their disease is a routine part of medical practice. AIDS has been scary
in the years since it was discovered precisely because of how infrequently
patients go into remission, compared to patients with many other dread
diseases. Any unusual case of AIDS becoming less grave in its symptoms in any
patient is well worth investigating, but it remains to be seen how well
understanding those rare cases will generalize to a cure or preventive
treatment for AIDS.

The big surprise about AIDS for people like me who were already reading about
medical research before AIDS was discovered is how effective antiviral
treatments for AIDS have been. The new approach of "treatment as prevention"
looks very promising, and there are patients who knew of HIV-positive status
in the early 1990s who are still alive and generally healthy--IF they are
consistent in taking their antiviral medications--today in 2012, which was not
at all expected by researchers even a few years before the protease inhibitor
medications were developed. Antiviral drugs are still rare, and AIDS has been
a surprising case of effective drug development on a very short time scale.

~~~
enraged_camel
Thank you for the detailed write-up. I'll definitely consider joining the
program!

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ars
"Also, the two patients whose cases were presented at the meeting are still
taking anti-retroviral medications normally used to treat HIV-positive
patients"

How are they trying to detect HIV while at the same time giving the drugs? The
drugs make it impossible to find the HIV.

~~~
Ergomane
Also note the qualifier: "in their blood cells". HIV reservoirs are not
necessarily restricted to blood or blood cell types.

You would expect that these patients need HAART to prevent a reactivating
virus from replicating. The Berlin patient is different* because particles
generated by a reactivated CCR5-tropic virus cannot infect his new
T-lymphocytes.

* though it remains to be seen whether he is truely cured.

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cmdkeen
Could someone in the know explain, given the costs and difficulty of a bone
marrow transplant, the likelihood of this becoming a treatment if it does
indeed pan out? My initial impression is that it would be very much a "rich
Western countries only" solution by a very wide margin.

~~~
crusso
_would be very much a "rich Western countries only" solution by a very wide
margin._

Assuming this method pans out as a cure for AIDS... what starts out today as a
solution for those with money causes interest in making it more widely
available. Interest leads to new techniques for reducing the cost and
complication of bone marrow transplants. Reducing the complication and cost of
bone marrow transplants spills over to benefit many other ill people.

Best of all, curing AIDS with any method whatsoever will likely lead to
discoveries about the very nature of the disease that could obviate the need
for a full marrow transplant.

~~~
Cass
The thing that makes bone marrow transplantation so expensive (about € 100.000
a pop in Germany, probably more expensive in the US) is that in the time
between killing off the patient's own immunosystem and the donor immunosystem
taking hold, the patient effectively has no immunosystem at all. This takes
about 100 days right now, during which the patient has to be isolated in an
environment almost entirely free of pathogens.

So if you want affordable bone marrow transplantation, you either need to find
a way to cheaply isolate someone while giving them a very high level of
medical care, find a way to grow a complete immunosystem in a few days, or
find a new drug that'll effectively fight off every possible infection in a
body with no protections of its own. Oh, and then of course you have to
affordably stop the donor cells from attacking the host's body, too. Finding a
cost-effective drug to cure AIDS looks a lot more likely to me than any of
that happening in my lifetime.

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thewileyone
My question is that only after 30 years they've discovered the procedure? Was
this the first attempt that trying this treatment? What's different now from
before if they had?

~~~
Ergomane
Such studies are done with patients who need BM transplants for unrelated
causes.

These cases are interesting to study because it teaches us what happens when
you do reservoir depletion while on HAART. This is a big topic in current HIV
research: reactivate integrated HIV to get the host cells killed while
blocking viral replication with HAART.

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keithnoizu
This is interesting news, large scale transplants do not sound like they would
be a viable solution but I wonder how much closer this takes us to applying
some sort of gene therapy approach to alter t cell production to mimic the
differences produced by this resistant strain of bone marrow.

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smallegan
Imagine how much HIV-Resistant Marrow would be on the open market.

~~~
aangjie
I don't think that's how this works. AFAIU, this works because it literally
wipes out your HIV-infected immune system and replaces it with a new one(not
HIV-resistant per se). Correct me if i am wrong.

~~~
smallegan
You are correct, I had misread this part:

"While the cells used in Brown’s transplant procedure were specifically chosen
from a donor who had a genetic mutation that resisted HIV, these patients
received transplants with normal cells."

It sounds like these were simply regular cells.

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vtry
White blood cell transplant can cure many previous incurable things, including
quite a few type of cancer. Too bad you'll have to go to China for the
procedure...

