Stem cell transplant has cured HIV infection, say doctors | Hacker News Reader

Stem cell transplant has cured HIV infection, say doctors

aidsmap.com

83 pointstimf40 comments

If this doesn't turn out to be overblown sensationalism, then the team behind this (actual!) cure probably deserves a Nobel for their efforts and results.

It's real, but not practical. The risk of death during a transplant like this is as high as 10%, because it involves completely knocking out the immune system.

I think most AIDS patients would gladly take that 10% chance.

AIDS has actually become manageable, and most HIV+ patients in the developed world die of other causes (cancer, aging, etc.) instead of AIDS. So I wouldn't be too sure.

And now HIV patients have a choice between manageable and treatable. For most of us, I think the choice would probably be obvious.

That depends on what exactly manageable means and what the risks of the cure are. The choice seems by no means obvious to me.

Here is a hypothetical example (because I don’t know much about HIV): Getting rid of frequent headaches (the hypothetical side-effect of managing a hypothetical otherwise deadly disease) with a cure that has a 1:5 chance of death doesn’t seem like a good deal to me.

You're right. The article implies no side effects other than the strict (even aggressive, if you will) treatment regiment, which does seem somewhat fishy.

HIV may not be a death sentence anymore, but it's still a serious disease with profound implications in one's lifestyle, and as far as I'm concerned, a cure can't come soon enough.

No, patients do not have this choice because no licensed physician would give them said choice. People here are talking as if BMT were this mundane thing that you can just decide you want to do some afternoon.

I'm not really sure what's the point you're trying to make. Bone marrow transplants are not some unproven treatment. Stem cell research generally seems troubling to some politicians; this specific application is probably not approved but I don't see any reason why it shouldn't be in the near future.

The mortality of the treatment that you and I are talking about is far higher than the mortality of the disease. Orders of magnitude higher.

Presumably that risk could be mitigated with improved processes (vacuum room?). If I read correctly, this was extreme application of an existing technique (chemotherapy).

Admittedly this is pretty intense, but so are treatments for cancer. Let's hope this leads to improved and safer treatments in the future.

It's a bone marrow transplant. The process is rather well established. http://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transpl...

I suspect that the mortality rate would be much lower amongst patients being treated for HIV. Bone marrow transplants as a therapy for leukemia requires killing the existing cells with radiation. This is completely sensible -- you've got some cancerous cells, so nuke everything and start over from the beginning.

Confounding the mortality stats is the fact that individuals undergoing treatment are very sick from the start. We might see better survival rates amongst comparatively healthy people.

In this case, you don't necessarily need a clean slate. "All" you need is a population of cells generating HIV resistant T-cells. AIDS manifests in individuals with extremely low T-cell counts. If a population of CD4 mutants could take hold within a larger population, it might be enough to prevent AIDS and bring viral titers low enough to eliminate transmission.

Nevertheless, I agree -- it's hardly practical, but it may be a beachhead.

I read an article back a few years, about how when they do a normal organ transplant (like a kidney) the patient benefits enormously from also getting a bone marrow transplant from the same donor. For a transplant you shut down the immune system completely, and keep it in a subdued state forever afterwards. With the matching bone marrow they could re-start the immune system to a mixed state afterwards, that accepted the original organs and the donation.

Anybody remember that article? I'd like to find it again.

They don't deserve a Nobel because the idea has been obvious in medicine for years. They just got very lucky in being able to deliver a confirmed CCR5 delta 32+ bone marrow transplant to someone with HIV in a medically responsible way.

Curing HIV is an incredible thing to have accomplished but the confirmation of a successful surgery from 3 years ago doesn't advance the bounds of scientific knowledge as much as it was might seem when you see a story like this in the news.

> They don't deserve a Nobel because the idea has been obvious in medicine for years.

What's your science background/what's your degree in? This really wasn't obvious. It was an open question as to whether or not other cells that were latently infected could produce a new infection via the other co-receptor (CXCR4).

> They just got very lucky

To characterize their hard work as luck is unjust. Yes, patients don't always survive bone marrow transplants, and this patient is indeed lucky to have survived. But the dilligent effort of his physicians is deliberate! Remember that they had to screen a lot of potential donors (61, I believe) to find someone with enough HLA similarity and a homozygous CCR5delta32 genotype. You can call this luck, but it's really just hard and dilligent work. Out of a pool of around 60 million people (worldwide) homozygous for CCR5delta32, you can find someone with enough matching allotypes. (You do know that you don't need all of the allotypes to match, right? That increases the probablity right there. In some cases, a little imperfect matching is a good thing, because the resulting graft-vs-host effect can act against the cancer you're trying to treat. Doctors have been using this effect since the 80s.)

Stem Cell Research must be allowed.

I came here to extoll the benefits of stem cell therapy with bio-matter obtained from the proper sources... but you beat me to it. :)

What are the "proper" sources?

Good question. If you lay out your options that you know about, I'll point out if there are among them any acceptable ones in my opinion.

Based on your username are you Jewish?

Because you'll be interested to know that Judaism not only permits embryonic stem cell research it actually encourages using the embryos rather than wasting them.

Nope, not Jewish. Only by stem cell. Religions are insufficient in some major ways. But they found time to include a clause about embryonic research, huh?

Are you looking for an answer or do you just want to be snarky?

I gave you what you need to know to answer your question... I don't care what a religion says. They usually don't know what they're talking about. I didn't know any religion validated embryonic stem cell harvesting and I am saying that completely honestly.

Agreed of course, though this really isn't the place or time to get political.

If I understand this correctly, these were stem cells from an adult donor who happened to be resistant to HIV, and there is pretty much no opposition* to adult stem cell research.

*well, some people of course oppose it, but the opposition worth mention is against embryonic stem cells.

Further elaboration: "Doctors chose stem cells from an individual who had an unusual genetic profile: a mutation inherited from both parents that resulted in CD4 cells that lacked the CCR5 receptor."

IIRC, there are only a handful of embryonic stem cell lines currently in active use. If one of them happened to be resistant to HIV I think we would have heard of it before now.

Certainly, if the apparent cure (which I hope and I'm sure the rest of the world hopes it is) came from embryonic stem cells, this would deplete any political capital held by the opposition to embryonic stem cell research.

As the cells came from an adult donor, though, the talking heads on both sides of the issue can rest assured that on a slow news day, they can still fall back on dogmatic opinion pieces!

The trick is that there are many sources of stem cells, some controversial, some most definitely not.

For instance: baby teeth[1]; amniotic fluid[2]; embryos[3]; fetuses[4]; and others. There are even "pluripotent"[5] cells which have similar attributes, which have even been created from skin cells.

"Stem Cell Research must be allowed": of course. Blanket bans are ignorant of the sources, and are effectively idiotic in the extreme. But which do you allow? And do you allow researchers to pay people for them? (note that this could mean abortions become profitable, if amniotic fluid / similar cells are allowed) And how do you get them? They're also still effectively human genetic experimentation - some people will never approve of that.

[1]: http://en.wikipedia.org/wiki/Stem_cell#cite_ref-60

[2]: http://en.wikipedia.org/wiki/Stem_cell#Amniotic

[3]: http://en.wikipedia.org/wiki/Stem_cell#Embryonic

[4]: http://en.wikipedia.org/wiki/Stem_cell#Fetal

[5]: http://en.wikipedia.org/wiki/Stem_cell#Induced_pluripotent

Indeed. It would help not calling them by a generic "Stem Cell research" name . Yes, some cell sources fall in the grey, almost black part of the line, but there are other being completely safe and out of ethical concerns. For example, discarded Placentas are full of them and doctors throw them away anyways.

Don't forget about adult stem cells, too. Those do count.

I didn't include those specifically because they're much harder to find:

>Pluripotent adult stem cells are rare and generally small in number but can be found in a number of tissues including umbilical cord blood.

Though I'm not sure if that has changed. I've generally gotten the impression that, while they can literally be found in every tissue, they're much harder to actually find, separate, and stimulate in usable quantities than the ones I listed. Umbilical cord blood is probably worth including though, yes, I think I've heard that's fairly high density. Though that's not what I'd consider to be "adult"; nearly anything to do with growing babies has stem cells.

You've got it right. Not all stem cells are equal,there's CD33+,CD34+,etc. They can be found in many places but the amount of cells matter.

Umbilical coord blood is awesome cause it's full of cd34+, but even then, even the amount of a really good collection won't support a full adult transplant cause the techology to grow and multiple the sample isn't there yet.

~2 years ago the top notch tech would only double the amount of a really good sample ,which would be about 2 ml.

What about human milk? I know I have read articles about breast milk/colostrum containing stem cells. Would this be an easier source than those mentioned in the wikipedia page? Of course, you still have the problem of finding lactating women willing to donate their milk in the name of science...

(Disclaimer: I know nothing about stem cells. I merely have an interest in the science of breast milk as a nursing mother. :) )

I agree with you, but if IRCC it's about funding. People have problems funding stem cell research when the cells come from certain places. I don't agree with them at all, but I can understand their point.

The difficulty with using HIV as your use-case argument is last I checked, most religious organizations considered HIV to be God's scourge on homosexuals.

e.g. they are not particularly worried about getting rid of it.

(I'm not just being snarky or sarcastic)

This is certainly not true with mainstream Christianity in the UK, although sadly some loud voices can be heard agreeing with what you say.

As just one example, Christian Aid, a large UK charity which works to end poverty and injustice around the world clearly states that HIV is a virus, not a moral issue: http://www.christianaid.org.uk/resources/policy/HIV_AIDS.asp...

If we need to get rid of religion first, so be it. Win-win.

Perhaps, if by "most religious organizations" you mean "a great number of fundamentalist-leaning Christian sects." But that is very different from "most religious people" or even "most Christians."

For example, approximately 50% of Christians are Catholics, which definitely doesn't teach that. The same holds true for Eastern Orthodox, Anglicans and other mainstream Christian groups.

See Catholic Charities: http://www.caritas.org/activities/hiv_aids/sinethemba_a_cari...

See this official Vatican statement on AIDS: http://www.vatican.va/roman_curia/secretariat_state/2003/doc...

Archbishop Leonard, the Catholic Primate of Belgium, considers the AIDS epidemic not at all a punishment from God, but 'a sort of intrinsic justice' for actions like promiscuity.

What a wonderful doctrine, huh...

Time to short CHD!

Just kidding. Or am I?

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