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Comment by krylon | Hacker News Reader

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.

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> 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.

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