

For the First Time in History Man Cured of HIV - azazo
http://thenextweb.com/shareables/2010/12/14/for-the-first-time-in-history-a-man-is-cured-of-hiv/

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acabal
From my friend, an HIV researcher:

Me: So is this genuine progress or breathless "science" journalism?

Him: A little of both to be honest. They basically replaced the man's entire
bone stem cell population with a donor's to "cure" him. Which only works for
one type of the virus. Which only works if you have an exact match for a bone
marrow donor. Which only works if the exact match happens to have the super
rare CCR5-32 mutation that makes them immune to that one type of virus. And
you get to take immunosuppressants for the rest of your life because you have
another dude's bone marrow in you. That being said, they cured HIV.

~~~
m_eiman
Couldn't they put the original bone marrow in a box somewhere, wait until the
borrowed marrow has done it's job and then replace the original one, to not
have to take immunosuppressants?

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Havoc
I don't think bone marrow transplants are quite that cut & paste.

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exch
Someone should file a bug report, cos that is obviously a design flaw.

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sp332
Cut and paste will be in the next release :-)

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electromagnetic
From my understanding HIV is a virus that infects immune cells and uses them
to replicate. What happened is that this man had his immune system almost
completely destroyed to defeat leukemia, and received stem cells from a donor
with the mutation CCR5 known for its reduced risk of HIV infection.

Basically they destroyed the HIV's food source, and likely (at least
temporarily) changed the man's new immune cells to the CCR5 variant in them
that reduced the effectiveness of the HIV's ability to replicate.

Again, from my lay understanding, HIV changes its cell protein markers to
avoid being attacked by immune cells. Often there are multiple HIV variants
with different protein markers at one time active in a person.

IMO all but the 'newest' variant likely died of attrition, leaving one or two
HIV protein marker variants that the new highly bolstered CCR5 mutant immune
cells managed to latch onto and defeat.

I could be way wrong, but from my understanding this is the closest 'model' I
can think of for how this would work. However, it's past my usual end-of-day
so it may just be gibberish of an overtired mind.

~~~
pak
Nitpick: Viruses don't consume food for energy, they feed off of the energy
metabolism of their host cell. CCR5 is a receptor that HIV binds to while
entering human cells. If it is mutated in a certain rare way, HIV has a hard
time entering cells, and it needs to be inside the cell to replicate. By
swapping out this guy's immune system with one that has mutant CCR5, they've
prevented HIV from replicating in his body.

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aresant
A sample of one is not a cure.

There is a controlled Clincal Trial in the recruiting stage for participants
surrounding CCR5 and its ability to block HIV.

[http://clinicaltrials.gov/ct2/show/NCT00842634?term=806383&#...</a><p>Sad not
to see that citation in every single one of the attached articles pounding the
drum.

~~~
wtallis
Thanks for the link. However:

This case _is_ a cure. HIV is pretty well known to not go away on its own
(except under the circumstances described in your link). This treatment is
almost certainly responsible for him no longer having HIV.

The notion that a cure must be widely applicable in order to _really_ be a
cure is rapidly becoming obsolete: many hypothesized or developing treatments
involving stem cells or genetics or bacteriophages are very specific, often to
the level of needing to be manufactured/cultured/etc. on a per-patient basis.
This makes them less useful, but really has nothing to do with their ability
to actually work.

This case is not announcement that a miracle drug will be hitting pharmacies
in a few decades, but it is proof (or at least, very strong evidence) that HIV
can be defeated _in vivo_.

~~~
alphaoverlord
1\. The notion that a cure must be widely applicable is the foundation of
clinical medicine, even with personalized medicine. You simply can't run
clinical trials with a sample size of 1. Just because an individual treatment
is tailored to the patient doesn't mean the process and plan of action is
generated new each time. The OP is stating how there is no way to generate the
'curative' stem cells and the odds of them appearing in natural populations is
extremely rare. This case is an awesome but exceptional situation, and is not
a basis to claim a breakthrough in the fight AIDS. As a proof of principle,
even anti-retrovirals show that an individual can be healthy post-infection.

2\. There are no FDA approved therapeutics for disease that use bacteriophage,
there is only some things as preservatives for meat. Most treatments of
genetic disorders are generally nonspecific - they treat symptoms and gene
therapy is still a developing field. Even in that case, the delivery vector is
usually generalizable - usable in many patients with slight individual
modification.

3\. in vivo refers to in glass, or in an experimental set-up, this is most
clearly not in vivo.

~~~
dandelany
>even anti-retrovirals show that an individual can be healthy post-infection

Anti-retrovirals only do so much - they have to be taken for the patient's
whole life. This is different, they are claiming that HIV has effectively been
eradicated in a living body, which just hasn't happened before. This isn't
meant to be a clinical trial, it's the only living proof we have that we can
kill all the HIV without killing the patient.

And you're mistaken about in vivo. In vivo = "within the living", in vitro =
"within glass" (& "in silico" = "within silicon", ie. simulated on a
computer).

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kurumo
I think this is the original article:
<http://www.nejm.org/doi/full/10.1056/NEJMoa0802905>

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madmaze
I would like to see the a Medical Journal Article referenced here. Needs more
testing, but certainly a great success, no matter what.

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bmelton
I have a friend of mine who moved away, so I now mostly keep in touch via his
blog. I've known him since 1995, and he's been HIV positive since I've known
him.

That said, within the past few years he was admitted to a similar clinical
trial that has all but eradicated the presence of HIV in his system. For at
least the past 6 months (it's under very close watch) there has been
absolutely no detectable traces of HIV in his blood.

This is far outside my general sphere of knowledge, so I'm apt to speak
unintelligently on the subject if I go into deeper detail, but it goes without
saying that we're ecstatic for him, his family, and everybody else in the
world plagued with the virus.

My biggest concern is the cost of the treatment. He's in trial, so it costs
him effectively nothing, but as the treatment is perfected and rolled out to
the masses, I have very little doubt that this will be affordable to only
those with the very best insurance or those with very fat pockets.

I'll reserve judgement on the morality of that, as I do believe the presence
of an expensive cure is infinitely better than the absence of a cure, but I'm
just hopeful that they can manage a way to ensure that it does in fact work as
they believe, and refine the process to such a degree that it becomes
affordable.

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adaml_623
This guy ended up with brain damage most likely from the treatment. If that's
part of the cure then I'm not sure it's worth it.

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younata

        20th century: "HIV is a virus, and viral diseases cannot be cured." [1]
        21st century: "Counterexample!"
    

[1] My understanding of diseases is weak. I remember being told that bacterial
diseases can be cured more or less trivially, but viral diseases can only be
vaccinated against.

~~~
natrius
Some viruses are better than others at staying around. Retroviruses, such as
HIV, have an enzyme called integrase that adds the virus' genes into your DNA.
That makes it particularly difficult to get rid of. Most viruses aren't that
good.

~~~
hartror
Funnily enough Retroviruses are also the major vector in gene therapy.

~~~
alphaoverlord
Retroviruses incorporate into the host genome and is important for gene
therapy. This allows for a long lasting effect and is essential depending on
cell type. Different cell types have different turn-around rates. If the gene
of interest is for a protein, you need incorporated DNA for continual
expression.

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ars
BTW, this isn't really the first time.

It's at least the third time.

There was a case where someone got a bone marrow transplant (because of
cancer) and the donor was immune to HIV which cured the recipient.

Also some people are naturally immune.

~~~
vlad
There has only been one case; all the articles you remember reading (including
this one) reference this one study.

~~~
ars
But that was in the news 2 years ago - why are we talking about it again?

[http://www.time.com/time/health/article/0,8599,1858843,00.ht...](http://www.time.com/time/health/article/0,8599,1858843,00.html)
<http://news.bbc.co.uk/2/hi/7726118.stm>

~~~
frisco
This is real science. It took three years to be sure; and for an announcement
like this, the investigators want to be sure before they put their reputations
behind it.

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latch
I know someone with MS who went through something similar with encouraging
results. I believe it was a mix of chemotherapy to suppress her own immune
system followed by a bone marrow transplant from a healthy donor.

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naughtysriram
Nice to hear this kind of break through! But is it attached to some kind of
controversy like stem-cell research/cloning? If new bone marrow is the cure,
then the next step might be a cloned bone marrow so you don't need to have
pills for ever! This might be opening a hole into advanced genetic research on
cloning stuff!!!!

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eof
I hope this isn't similar to Assange getting bail and NASA discovering arsenic
based life.

