
HIV Is Reported Cured in a Second Patient - aaronbrethorst
https://www.nytimes.com/2019/03/04/health/aids-cure-london-patient.html
======
rayiner
As a kid who grew up in the 1990s, I consider this the biggest technological
advance in my lifetime. HIV was a death sentence back then. Arthur Ashe died
of it in 1992, and Magic Johnson announced he had it in 1991. It was in our
minds right up there with global warming and the hole in the ozone layer as a
existential threat to humanity. And now... a 20-something who begins
antiretroviral therapy today can expect to live into his or her late 70s. It's
a scientific miracle.

~~~
sizzle
And yet some of the brightest analytical minds are regularly drawn to the big
dollar signs that comes with optimizing advertising tech at FAANG companies
when they could be curing cancer.

~~~
skrebbel
I never understood this sentiment. I'm good at JavaScript, not biochemistry.
How will I be curing cancer? Trick the cancer cells into calling undefined as
a function?

~~~
TeMPOraL
It's not a criticism at your individual specialization. It's _fucking hard_ to
get into cancer research at this stage, though if you know the right people,
you could maybe help scientists with some simulations or visualizations or
whatever other tangential concern that requires JavaScript knowledge.

This is a complaint against the market at large. There is work to be done in
things like curing cancer(s) and mitigating climate change, but the jobs are
few, far between, and pay peanuts. Meanwhile advertising is a direct social
negative (IMO a cancer on human society), but it offers plenty of positions
with good wages. The choice thus becomes: take the hard road and a paycut to
maybe help some unspecified amount of people you don't know, vs. take the easy
road with good wages and hurt an unspecified amount of people you don't know.

This complaint is about the market, and it's essentially the same thing you
may say during debugging some algorithm: "I understand the steps it make and
they all look good, but the _final result is wrong_ ".

~~~
Erlich_Bachman
> Meanwhile advertising is a direct social negative (IMO a cancer on human
> society)

Wow wow wow you can't just make a claim like that without any basis
whatsoever? It might be true or not, but would you mind collaborating on why
you think that? I am not even talking about proving it with some science
(which is likely very hard), but you just write it off as if everyone else is
sharing your view and as if it is self-explanatory or widely accepted. It is
not.

Capitalism and the product culture has led to the most technological and in
many case, lifestyle, lifespan, and life standard advancements known in
history. This way of propelling progress forward requries efficient markets,
and markets need to connect products with people who want and can benefit from
those products. No advertisement is directly forcing anyone to buy or do
anything, they just provide information for people and help locating people
who might otherwise not have knowledge of the products they might want.

Assuming your take on the advertisement industry is different, what is that
take?

~~~
bryanrasmussen
I would think the feeling that marketing as a whole, and advertising as part
of it was a large social negative was prevalent enough that one would not have
to explain it even if not everyone agrees.

I mean it's common enough that Bill Hicks on the subject is pretty much a meme
by this point
[https://www.youtube.com/watch?v=tHEOGrkhDp0](https://www.youtube.com/watch?v=tHEOGrkhDp0)

I'm not saying I necessarily agree, but if someone says advertising is a
cancer on society or something like that I would not be like - whoa what
particular belief system has led him to conclude this?!? - I would think, huh,
they have that set of beliefs regarding advertising and marketing.

~~~
Erlich_Bachman
So, one more time, care to explain why you think that it is? Or am I to
understand this correctly that you think it's "cancer" on society because you
have just heard other people say that (like Bill Hicks and perhaps others you
respect) and you assume it was prevalent?

It would be interesting to understand your original arguments if it was more
clear what you based that assumption on (which is by no means universal).

~~~
bryanrasmussen
1\. you might notice that it was not me that made the original arguments, I
just noted my surprise that you needed understanding of the viewpoint since
I've seen it expressed throughout the internet at various levels of lucidity
for the last decade at least.

2\. one expression might be this [https://ioptconsulting.com/online-
advertising-is-the-new-dig...](https://ioptconsulting.com/online-advertising-
is-the-new-digital-cancer/) if the Bill Hicks expression of it was not to your
liking.

3\. again, I was not arguing for the correctness of the belief that
advertising is a cancer, I just noted that nobody should be surprised at it's
existence. Maybe it's like this XKCD
[https://xkcd.com/1053/](https://xkcd.com/1053/) in which case
congratulations, I've now given you two links to why people think advertising
and marketing are awful awful things.

Again, I do not necessarily see advertising as something that is cancerous,
but I am familiar with expressions of the idea so I am not shocked, shocked
when I encounter it.

------
ausbah
Personally, I wish what would really get attention in the realm of HIV
treatments is invention and subsequent spread of "prevention" drugs like PrEP
(significantly lowering chances of getting HIV if taken daily) and PEP ("fight
off" HIV if possibly exposed to it in the last 72 hours), in addition to
amazingly high level of quality that HIV therapies have reached such that if
HIV can't be detected - its effectively untransmittable.

Not trying to draw attention away from the potential significance of the
article, would just like more of the "widespread", effective treatments get a
little light.

~~~
torstenvl
I'm on PrEP. It was astoundingly hard to get on. So many primary care doctors
have no idea what it is or why to prescribe it.

~~~
gadders
Is that covered by insurance? In the UK, some people are expecting the NHS to
pay for it.

~~~
xfitm3
The NHS absolutely should pay for it.

~~~
gadders
I disagree. The steps to avoid requiring it are well understood.

If people want to indulge in "risky" behaviour, I have no problem with that. I
just don't want to pay for it out of my taxes. It's like someone who makes a
habit of jumping out of aeroplanes complaining that the government won't pay
for his parachutes.

~~~
kevinh
Should the government not pay for costs due to pregnancy? The steps to avoid
it are well understood, and it does cost a lot of money.

~~~
gadders
Yeah, not sure you can class promiscuous shagging to bringing a child into the
world.

~~~
foldr
That’s just straight-up homophobia, which is not ok on HN. Most HIV
transmission occurs within relationships, and most causal sex (gay or
straight) happens indoors and in private.

Your edit doesn't really make sense, as a quite a lot of children are the
result of "promiscuous" sex, and the NHS still pays for the relevant care.

You're still ignoring the fact that HIV transmission typically occurs in the
context of regular sex with the same person. Having one-off sex with strangers
actually isn't a particularly efficient way of becoming HIV positive.

~~~
gadders
Well, I'd say one was the most important thing most people will do, and
evolutionarily their whole reason for existing.

Absent being a sex worker, the other is just hedonism.

~~~
foldr
Weirdly, you seem to be missing the fact that children happen as a consequence
of sex (and not uncommonly as a consequence of promiscuous sex).

Accidentally becoming pregnant can be _exactly_ as "hedonistic" as
accidentally becoming HIV positive.

------
Herodotus38
This is using a stem cell transplant again like the first person which carries
a high risk of lifelong complications and death. While awesome, this is not a
realistic or great option for patients without another issue needing a stem
cell transplant. With modern HAART therapy one is expected to live as long as
the average non-HIV infected patient in the US.

~~~
fastball
HIV is still transmissible even with HAART therapy, so I'm not sure how it's
relevant to the discussion of a cure.

~~~
woofyman
Undetectable also means non transmissible.

~~~
toomuchtodo
Bold claim. How recent are HPV tests?

Edit: While my comment came from caution due to historical human hubris, it
appears I am wrong:

“According to the Centers for Disease Control and Prevention (CDC), a person
with an undetectable viral load has “effectively no risk” of sexually
transmitting HIV. In 2016, the Prevention Access Campaign launched the U=U, or
Undetectable = Untransmittable, campaign.”

~~~
pryce
That claim isn't a bold assessment of the medical literature at all, it's
actually widely held to by the medical organizations responsible for HIV
treatment and prevention.

Here [1] is for instance an article referencing this claim, describing it as
"based on strong scientific evidence" that was peer reviewed published by the
journal of the American Medical Association. (EDIT: it's important to add the
caveat, which is that this claim is about sexual transmission only, and does
not cover pregnant-mother-to-child transmission or intravenous needle
sharing).

Also your comment now refers to "HPV" which is the name of a different
disease.

[1] [https://jamanetwork.com/journals/jama/article-
abstract/27209...](https://jamanetwork.com/journals/jama/article-
abstract/2720997)

~~~
toomuchtodo
I refer to HPV as a case study in humans not having tests available for a
communicable disease (no HPV test exists for men) and underestimating it’s
communicability (not to mention it’s role in causing several types of cancer).
Apologies if you thought I was confusing HPV and HIV.

Too often we think we’re smarter than we are, and the consequences can be
damning. Hence why I said its a bold claim that undetectable means it can’t be
transmitted. Are we absolutely sure? Because if we’re not, someone could
acquire a life long chronic disease that would otherwise have been
preventable. But the CDC says undetectable says no transmission; I hope
they’re right in 100% of transmission scenarios.

------
canada_dry
I assume it's the same method they've successfully used to eliminate Multiple
Sclerosis.

[https://www.bbc.com/news/health-43435868](https://www.bbc.com/news/health-43435868)

How are we not pumping billions more into stem cell research?!?

~~~
steelframe
I've had MS for 20 years.

The procedure for MS is HSCT. It's erroneously called "transplant," as it
actually is stem-cell rescue. The basic idea is to extract your own stem
cells, kill of most (not all) of your existing immune system, and then re-
infuse your stem cells to "reinstall" your immune system. Hopefully before you
get an infection while you don't have any defenses.

This treatment has been shown to be effective for the most mild form of MS,
Relapsing Remitting (RRMS), and only in the early stages of the disease. It's
relatively risky, and if we were to do the procedure for everyone diagnosed
with RRMS today, hundreds (if not thousands) of people would die from the
treatment. Either from complications from the procedure, or from increased
instances of cancer years down the road, since the poison part of the
treatment is known to be carcinogenic.

Meanwhile, there is Rituximab, which is a monoclonal antibody targeting the
CD20 protein that has had its patent recently expire. This means it can be
manufactured as a generic. Clinical trials recently run in England have shown
that not only is it extremely effective at controlling the disease in the most
mild form (RRMS), but CD20-targeting monoclonal antibodies are the only drugs
known to be in any (meaningful) way effective for the more serious forms of
the disease, Secondary Progressive (SPMS) and Primary Progressive (PPMS).

Given the choice between HSCT or Rituximab, in terms of effectiveness, safety
and cost, Rituximab wins as a treatment for MS, hands-down.

For those stuck in the United States, the FDA will let you get Ocrelizumab
(Ocrevus), which is basically Rituximab tweaked enough so that Genentech could
get patent protection for it. With that patent protection, they got the
financial incentive to run it through the FDA approval process so they can now
sell it to you for the bargain price of about $80,000 per year. It's just
about as effective as Rituximab and maybe only a little more dangerous.

~~~
ascorbic
And for those wondering, in the UK Rituximab costs the NHS £349.50 for a
course. [https://bnf.nice.org.uk/medicinal-
forms/rituximab.html](https://bnf.nice.org.uk/medicinal-forms/rituximab.html)

~~~
pedrocr
That link only works if you are in the UK.

~~~
SamuelAdams
[https://en.wikipedia.org/wiki/Rituximab](https://en.wikipedia.org/wiki/Rituximab)

> In the United Kingdom this amount cost the NHS approximately £182 in
> 2015.[9] The average wholesale price in the United States of a typical
> treatment for rheumatoid arthritis (1,000 mg IV dose, 2 weeks apart) would
> have been $14,100 a month in 2014 ($705 per 100 mg)[10] but the patent
> expired in 2016.[

------
xfitm3
While this treatment course doesn't appear to be without serious side effects
or scale well let's not lose sight of the real win here. Reinforcing that a
cure is possible.

"The surprise success now confirms that a cure for H.I.V. infection is
possible, if difficult, researchers said."

~~~
ddebernardy
^ So much this. For everyone of us who know and care about someone who has
HIV, and for everyone who has it, it's basically a sunbeam of hope --
regardless of how effective or not it turns out to be in practice.

~~~
gregimba
Especially people who both parents died of age like my siblings. It gives you
hope for a future where that won't be the outcome.

------
pgrote
The existing research of the berlin patient
([https://en.wikipedia.org/wiki/Timothy_Ray_Brown](https://en.wikipedia.org/wiki/Timothy_Ray_Brown))
indicates the likely elimination of HIV was graft vs. host disease
([https://en.wikipedia.org/wiki/Graft-versus-
host_disease#HIV_...](https://en.wikipedia.org/wiki/Graft-versus-
host_disease#HIV_elimination)).

The NY Times doesn't mention graft vs. host, but the doctor treating the
berlin patient says no one else was cured undergoing the treatment the berlin
patient underwent. According to records, 6 additional people were thought to
be cured. I couldn't find any follow-up on them.
([https://www.newscientist.com/article/mg23431244-400-immune-w...](https://www.newscientist.com/article/mg23431244-400-immune-
war-with-donor-cells-after-transplant-may-wipe-out-hiv/))

~~~
rincebrain
[1] suggests this was also true here, but AFAICT the other patients they've
tried this on to see if it was just graft versus host all wound up relapsing
(I swear there was another study of this negative outcome with n>2, but I'm
not turning it up, so maybe I'm full of it). [2]

Though [3] claims another set of experiments with this resulted in 5
cured/undetectable patients and one remission who was allegedly an odd duck
out in terms of treatment (cord blood versus bone marrow),

[1] - [https://www.theguardian.com/society/2019/mar/05/london-
patie...](https://www.theguardian.com/society/2019/mar/05/london-patient-
becomes-second-man-to-be-cleared-of-aids-virus)

[2] - [https://www.nature.com/news/hopes-of-hiv-cure-in-boston-
pati...](https://www.nature.com/news/hopes-of-hiv-cure-in-boston-patients-
dashed-1.14324)

[3] - [https://annals.org/aim/article-
abstract/2707334/mechanisms-c...](https://annals.org/aim/article-
abstract/2707334/mechanisms-contribute-profound-reduction-hiv-1-reservoir-
after-allogeneic-stem)

------
phkahler
Bone marrow transplants are a very high risk procedure. Something like 50
percent work, while the rest die shortly after. I knew a guy with cancer that
did it as a last resort treatment. They killed all the marrow (whatever kind
of cells, I'm not a doctor) and reintroduced some to take over. It took. And
then they found the sample they reintroduced (they used his own) was tainted
with cancer. He died shortly after. Had it not been tainted he would have been
cured. Taking the cells from someone else means getting it cancer-free but
also means higher risk it won't work. It also provides the opportunity to give
the person an AIDS-proof immune system (which some people have). This is not a
generally usable cure, but it is cool AF when it works.

~~~
vagab0nd
Is that why people freeze and save their stem cells? Would it help in this
case?

~~~
phkahler
I think that's the type of scenario they think might be possible some day. I'm
not sure if there are any actual treatments that rely on frozen stem cells.
Turns out you can convert some cells to stem cells, and there are some other
sources.

------
peter303
This was only the second cure of several dozen similar marrow transplant
procedures ech costing on the order of six figures. And with 50 million around
the world infected and 40 years of searching for a reliable cure.

Its far more likely that a million were saved by having a rare mutation (1%
population) that prevents HIV infection. The recently disgraced Chinese
scientist used CRSPER/CAS9 genetic engineering on human embryros to induce
this immunity into people who lacked it. The experiment was conducted in a
totally unethical way with the scientist under criminal investigation. But the
goal was noble.

------
neokantian
_CCR5 is the protein that He Jiankui Mengele, a scientist in China, claimed to
have modified with gene editing in at least two children_

------
bcks
Related: whatever happened to The Immunity Project, the AIDS vaccine funded by
Y Combinator in 2014?
[http://www.immunityproject.org](http://www.immunityproject.org)

~~~
hayksaakian
Check out the linkedin profiles for people on this page

[http://www.immunityproject.org/team](http://www.immunityproject.org/team)

Seems like some of them have left, otherwise still active?

The website has not had any new updates since 2016 though which is worrying.

------
Kye
Caveat: one kind of HIV.

>> _" This is only going to work if someone has a virus that really only uses
CCR5 for entry — and that’s actually probably about 50 percent of the people
who are living with H.I.V., if not less"_

~~~
burlesona
Yes, but an actual cure for up to half of people with HIV would still be a
huge positive.

~~~
WrtCdEvrydy
Standby for insulin pricing!

~~~
lojack
Which is completely irrelevant to this because insulin isn’t a cure and has
been around for nearly a century.

------
temporalparts
> But rearming the body with immune cells similarly modified to resist H.I.V.
> might well succeed as a practical treatment, experts said.

Do people know what is the existing literature on injecting or transplanting
different or modified immune cells into someone as a general class of cures?
Seems like this could generalize into something of an alternative to vaccine
(or a different class of cures).

~~~
zaroth
There’s a massive arm of cancer research devoted to exactly this, called
immunotherapy. It’s where many of the best new treatments are being discovered
lately. People are calling it the new chemo.

It’s particular promising in leukemia, for example.

Typically involves injecting a growth factor and then harvesting stem cells
from peripheral blood (as supposed to having to go into the marrow directly),
then processing the cells in some way to make them more antagonistic to the
cancerous mutations.

In some cases the cancerous cells will be tagged with some marker that can
then be used as a target site the extracted cells can be trained on.

Then the patient’s own stem-cells are transplanted back into their body to do
their work.

Sometimes the patient gets ablated before reintoducing the new cells. That’s
called an autologous (“auto”) stem-cell transplant.

------
wuschel
The infection with the _HIV_ virus leads to the _AIDS_ decease.

It is sad to see that even the NYT can't get things straight when it comes to
science.

I am very curious about the paper/data. For now, the typical newspaper
headline does not mean a thing to me.

~~~
onychomys
Assuming you meant "disease" instead of "decease", that's literally what the
very first line in the article says. I'm in HIV research, and I have only the
most minor nitpicks with the article's science.

~~~
wuschel
Indeed, I meant disease.

I meant the title, not the article itself.

So much for making quick and precise comments on HN.

------
edoo
My first thought is to short condom manufacturers but when I think about it
most of them are one of many many brands of a conglomerate.

------
dana321
Perhaps the bone marrow was from one of the rare occurences of people who are
immune to HIV

------
jjtheblunt
entirely implausible, if the virus rewrites the host dna via rna...a rootkit
in biology

------
HNLurker2
Didn't Asimov died of HIV from wrongly transplant

~~~
HNLurker2
[https://old.reddit.com/r/todayilearned/comments/akylvy/til_i...](https://old.reddit.com/r/todayilearned/comments/akylvy/til_issac_asimov_contracted_hiv_from_a/)

------
peter303
The scary thing is that humanity is highly susceptible to another plague
whether it is STD like AIDS or some other transmission. We live in contact
with strangers. Air travel can carry a diseaes around the world in a couple of
days. This was depicted in many scifi movies like Contagion.

And gays have not really changed their habits. If you read the profiles on
Grindr, the gay hookup app, many people claim to be on the prophalyptic PReP
drug regime which allows the more pleasurable and dangerous version of
unprotected sex. It wont be HIV but something new.

Humankind has lived with plagues for 10,000 years since agriculture and
urbanization has created the population density that allow plagues to
flourish. There are plenty of stories where some plague kills off half to 90%
of a village goinf all the way back to Classical Greece.

~~~
onychomys
HIV is a disease of gay men in the western world, but that's not true
elsewhere. Most infections in Russia are from intravenous drug use. Most
infections in sub-Saharan Africa are from heterosexual sex. Your science is
bad.

~~~
foldr
HIV disproportionally affects gay men in the west, but only about 50% of HIV+
people in the US are gay.

------
NN88
> _One important caveat to any such approach is that the patient would still
> be vulnerable to a form of H.I.V. called X4, which employs a different
> protein, CXCR4, to enter cells._

> _“This is only going to work if someone has a virus that really only uses
> CCR5 for entry — and that’s actually probably about 50 percent of the people
> who are living with H.I.V., if not less,” said Dr. Timothy J. Henrich, an
> AIDS specialist at the University of California, San Francisco._

> _Even if a person harbors only a small number of X4 viruses, they may
> multiply in the absence of competition from their viral cousins. There is at
> least one reported case of an individual who got a transplant from a delta
> 32 donor but later rebounded with the X4 virus. (As a precaution against X4,
> Mr. Brown is taking a daily pill to prevent H.I.V. infection.)_

This...leaves a lot to be desired...

------
YesThatTom2
I call bullshit.

As a kid who grew up in the 1980s and suffered through endless funerals and
stuff, I also observed that any time a research lab was nearly out of funds,
they'd send out a press release claiming something that sounded important, but
wasn't. The local congress person would find funds to keep the research group
going and "save the day".

The research that was "saved" was usually an impressive-sounding tidbit that
wasn't really impressive. "Kills HIV in the test-tube" became a red flag for
me... that was always an indicator something fishy was going on. HIV is easy
to kill. oxygen kills it. Sadly, you can't pump pure oxygen into the blood or
the patient dies. Killing HIV in a testtube was the experiment you did to get
PR and more funding.

One person "cured" is an anecdote, not a breakthrough. Occasionally people's
bodies cure themselves. After 12 years of trying someone was "cured"? I'll
believe it when I see it done in a repeatable way.

Sorry for being such a downer. I've had my heart broken too many times.

~~~
johnmarcus
it wasn't all bullshit though, you were just to young to understand the
concept of how science works. you thought breakthroughs were cure-all's, when
really they were incremental improvements. By the 90's, they had meds which
has allowed patience to live long and relatively normal lives - those meds
came from the scientific breakthroughs of the 80's which you despise so much.

Likewise, no one is saying this a practical cure - but scientifically speaking
these are two individuals whom have been relieved of the disease, thoroughly
confirmed, and now with two patients, a replicated process (however
impractical it is).

Sorry for your losses, just saying, you shouldn't 'shit' on peoples hard
scientific work because it didn't fulfill your hopes and dreams.

