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Comment by acabal | Hacker News Reader

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.

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"This is not prime time to me at all. This is a very unusual situation that has little practical application for a simple reason. This donor not only had to be a good compatible match, but the donor had to have a genetic defect of cells that do not express the receptor that the HIV virus needs to enter the cell."

"This patient is trading one poison for another. He may not have to be on antiretroviral drugs anymore, but he has to take immunosuppressant drugs now to prevent the rejection of his transplant cells. Again, what this is, is an interesting proof of concept, but it's absolutely impractical."

- Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases

Source: http://www.foxnews.com/health/2010/12/14/doctors-claim-hiv-p...

This procedure has a >10% mortality. The annual mortality from HIV in 2010 is how many orders of magnitude lower than 10%?

And why were they willing to do this risky procedure for this patient? Hint: not because of his HIV.

This is an example of a huge story that nevertheless got enormously overblown.

Whether the treatment is is worse than the disease is less relevant here than the fact that this proves it is in fact possible to cure. With that knowledge, we can pursue techniques that won't hopefully won't have such drastic consequences.

Most researchers already agree that it will be soon possible to cure HIV. Antiviral therapies, while not yet well known, are becoming mainstream. I wouldn't call this a "cure", but rather evidence that one person's immunity to a specific form of HIV can be transferred to an person infected with that form to prevent it from replicating. It supports existing claims about the role of CCR5 in HIV's life cycle and the protective effects of its mutation. There is no reason to preface this with "For The First Time In The History Of Man" or anything so dramatic.

If you have friends who have HIV/AIDS, you'll be more appreciative of the dramatic flair.

Since this cures you for life, comparing it with the annual mortality rate doesn't seem appropriate. Better to compare the average life expectancy with and without the procedure.

Is taking the immunosuppressants for the rest of his life aspect unique to his particular bone marrow transplant procedure? My father had a bone marrow transplant several years ago, and was off medication within a year IIRC. (At the least, I know he takes no medication currently.)

The article does say 'stem cell replacement'. I'm not medically savvy enough to know how different that is from the 'traditional' bone marrow transplant. Can someone help me out?

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?

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

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

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

Of course, but with a bit of research it might be a better long term alternative; suppressing the immune system isn't something that'll ensure longevity.

Your chance of survival would go from (0.9) to (0.9*0.9).

Also, this paper hasn't actually proven a cure. It has clearly demonstrated long-term suppression. However, by replacing the CCR5-deficient T cells with his regular cells, you'd certainly test the hypothesis. There is also the risk that you would be reintroducing HIV-infected cells.

Isn't there the issue that his original bone marrow (which you've temporarily removed) is probably infected with HIV? Returning it at a later date would reinfect him.

However, what this does show is that CCR5 is more than simply protective (which we knew) it could, if properly targeted via therapeutic intervention, eventually cure someone.

This is very similar to a south park episode. Guy runs to a bunch of dying, dirt poor people in affrica "We have the cure for AIDS! You just have to inject 500,000 dollars directly into your veins! Woo!"

Basically this "cure" is of the type where the guy was about to die, he underwent a procedure that had a 50% or so survival rate, upon success he is cured of most strains of HIV.

Hey its great, we know this thing can be killed. Lets see if we can put that knowledge to work. But this is not a generic "cure".

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