Man unexpectedly cured of HIV after stem cell transplant | Hacker News Reader

Man unexpectedly cured of HIV after stem cell transplant

newscientist.com

159 pointsdoener33 comments

I vaguely recall there was a case a few years back where a patient had been cured of HIV. But they had effectively their entire immune system wiped out by radiation therapy or something along those lines, and then received a bone marrow transplant from a healthy donor. So not something that could easily be replicated in many patients.

Still, that is big news, considering how many people have died from HIV, and how many still live with the virus. Treatment has come a long way - I remember how it was practically a death penalty in the 1990s; but a complete cure would be so much better than depending on medication for the rest of one's life. I don't think this is the breakthrough, but it is proof that search for a cure is not futile.

> I don't think this is the breakthrough

Definitely not. Five year survival rate for stem cell transplants is about 50%. People with HIV now have effectively normal life expectancies provided that they're treated. Even if this worked reliably, it would be _very_ much a case of the cure being worse than the disease.

How much of that low survival rate is due to the condition they received the transplant, though? Conceivably a patient with "just" HIV might do better than one with eg. leukemia and HIV.

That said, IIUC the whole stem cell transplant procedure is unpleasant enough that it still might not be worth it.

About half?

"The major cause of death is relapse, which accounts for approximately 40% of all deaths, followed by infections at 25% and graft-versus-host disease (GVHD) at 20%."

https://www.sciencedirect.com/science/article/pii/S266663672...

A good friend of mine died from a C. Diff infection in the hospital after a bone marrow transplant. It is very risky, especially with an imperfect match.

That said, you can help make it less risky! This used to be called "Be The Match", not sure why they renamed it but you could save someone's life by registering to be a donor:

https://www.nmdp.org/

I donated bone marrow through Be the Match (before they changed their name). It was painful, but I highly recommend the experience to folks whenever it comes up.

You get to save the life of a stranger AND they give you a t-shirt. Win win!

I think its been done a few times [1]. Crudely put: try to wipe out as much of the immune system then replace with stem cells from a donor. Previously they used donors who had a gene mutation that made them HIV resistant, but this was with 'normal' genes. But a stem cell transplant may have worse survivability than HIV for many people

[1] https://www.nbcnews.com/health/health-news/7th-person-hiv-cu...

https://www.webmd.com/hiv-aids/hiv-remission

There is at least one documented case of someone using anti-retroviral therapy, getting their viral load down to undetectable, stopping the therapy and remaining undetectable for years without continued therapy. They use the word "remission" rather than "cure" because there are fragments of viral dna that remain in your cells and it's possible for a "reservoir" of inactive virus to exist and activate, so there will always be regular testing involved in any attempt to eliminate the virus entirely, but whether it technically counts as "cured" becomes a nearly-moot point when one is able to live the same way that someone who has never been exposed lives save for the testing.

I know what you were getting at but I think it’s important to point out that people don’t actually die from HIV they die from AIDS which is caused by HIV.

I'm probably 30 years late in asking this, but why does it strike you as an important distinction?

Why would it not be? It's like the distinction between "a crocodile" and "being mauled" or "a credit card" and "crippling debt"; while they may frequently co-occur, either can exist without the other. Further, recognizing that they are distinct allows you to build causal models, which are vital to taking productive action.

Honest question: Are there alternative ways people can get AIDS? If so, it's news to me.

Various other viral (and even less commonly, microbial) challenges, though it's rare. HIV is special in this regard because it's the only example (so far as I know) that's transmissible.

Haven’t they done exactly this several times already?

Edit: Yep.

https://www.nature.com/articles/d41586-024-02463-w

It’s happened at least 5 times.

The novelty of this (not captured in the headline) is that the man received non-resistant stem cells .

I believe in all previous cases the donors had mutations of the CCR5 gene which made them resistant to HIV.

Second sentence from the article:

> Significantly, he is also the second of the seven who received stem cells that were not actually resistant to the virus, strengthening the case that HIV-resistant cells may not be necessary for an HIV cure.

Yes, but why read the first paragraph of an article when you can write a comment to demonstrate your knowledge and ignorance simultaneously?

As the sentence right below the title says:

> A handful of people with HIV have been cured after receiving HIV-resistant stem cells – but a man who received non-resistant stem cells is also now HIV-free

People have to understand that individual cases of effectively curing HIV via stem cell transplants are merely providing a few puzzle pieces to HIV research, if at all, but have no clinical applicability, as a stem cell transplant is always an extreme, dangerous and last-resort treatment for otherwise unmanageable diseases, as which HIV generally does not count anymore.

People also have to understand that some weapons are useful having just in case, and that we might be a few mutations away from HIV becoming unmanageable again.

I don't think you understood the parent post.

The point is that this is not repeatable: curing HIV isn't something we now know how to do.

The second point is: this did not give us a significant new insight into the causes or mechanisms of treatment of HIV

> curing HIV isn't something we now know how to do.

Technically we do but we will never ever give someone a stem cell transplant to cure their HIV because there are SIX highly effective different classes of medication to treat HIV. Majorly treatment resistant high fitness HIV is NOT a concern on the horizon.

> The second point is: this did not give us a significant new insight into the causes or mechanisms of treatment of HIV

The first unique cases of both variants of this DID lead to significant, valuable insights in several areas. But further cases, not so much. Myeloablation clearing the HIV reservoirs while the patient continues being on ART leading to a total cure does not excite any knowledgeable scientist anymore in 2025.

This is the 7th case, so this seems like a bigger puzzle piece.

My sister in law has a stem cell transplant under this team https://sheffield.ac.uk/neuroscience-institute/research/brea... for Multiple Sclerosis. It was a small multi-country trial of about 100 people, I recall. This was nine years ago and she counts herself as cured, though to has a follow up once a year with the same team. The treatment is expensive, and though this was all UK National-Health-Service linked, the NHS is seeking cheaper MS treatments now: https://www.mssociety.org.uk/research/latest-research/latest... (Metformin, ALA, ?) There was a trial before this trial - some 20 people in Canada (?) and a couple died. In the 100 person trial they changed the selection criteria for patients, and I'd like to think nobody died cos of the treatment, but I've not heard anything to be able to add a figure. Its Mexico only now perhaps, people did self-fund to go to Moscow for the same treatment: https://www.bbc.co.uk/news/uk-scotland-54560236. These two ladies are not updating how it went for them, years later, but one is on Instagram living a normal life, and the other Facebook

If I’m reading this correctly it sounds like it might a kind of beneficial graft-vs-host reaction?

The HIV-free transplanted immune system sees the original immune system as alien, and proceeds to wipe it out at the cellular level. This presumably takes the HIV with it, even if the new immune system is not itself resistant.

I guess this means that quiescent HIV is not at a stage in its lifecycle where it can reinfect cells if its host cell is destroyed. My hilarious mental model of infectious HIV virions floating inside a CD4+ T-cell like angry bees inside a balloon is clearly mistaken.

https://archive.ph/8e3sM

It sounds like stem cells could be used to cure people from a variety of viruses in the near future

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