HIV "cure" thoughts?

[blindsideflank]

hey just read this article, it may be older news than i thought but i figured with the holidays approaching we all have spare time (relative to our normal lives) so one more thread on here is acceptable.

 

http://bloodjournal.hematologylibrary.org/cgi/content/abstract/blood-2010-09-309591v1

 

http://www.boiseweekly.com/Cobweb/archives/2010/12/14/study-indicates-potential-cure-for-hiv-found

 

The medical journal, Blood, published by the American Society of Hematology, just released the results of a German study indicating that stem cell transplantation could cure HIV.

 

The paper discusses the case of Timothy Ray Brown, who underwent a stem cell transplant as treatment in 2007 and appears to be the first person ever cured of the disease as a result.

 

While more research is required, this is still good news that may provide hope for the approximately 33 million people living with the disease worldwide, including approximately 2.5 million children born with the disease.

 

 

thoughts? anything to add to this

[Ubiquitine]

I've just download the entire article, didn't read it all but seem very interesting. Don't know why it wasn't more publicized ?

[cheech10]

Unfortunately, allogeneic stem cell transplant recipients face a host of chronic diseases: graft vs host disease, recurrent infections, toxicities of their immunosuppressants. I'm not sure their quality of life or life expectancy is any better (and may be worse) than an HIV positive individual on HAART. It's basically trading one disease for another.

 

A similar example is pancreatic transplants/islet cell transplants and diabetes. Are the outcomes any better post transplantation?

[Karma]

I read about this some time ago and was really excited!

 

Even if this kind of surgery is still very risky (50% mortality rate) I think it's still something that can give hope to people with HIV. It's the only thing that seems to work at eradicating the virus so far.

[blindsideflank]

http://singularityhub.com/2010/02/26/stem-cell-transplant-defeats-hiv/

there would not be any complication of graft/host i thought...

 

infection is the obvious on to me, seen many post op etc. pts go down the tube because of sepsis, pneumonia when they have a deppressed immune system.

 

the above link actually has a lot of cool articles on slightly similar treatments for many conditions

check out the crohns one too

[A-Stark]

I read about this some time ago and was really excited!

 

Even if this kind of surgery is still very risky (50% mortality rate) I think it's still something that can give hope to people with HIV. It's the only thing that seems to work at eradicating the virus so far.

 

HAART can - and often does - reduce viral load to undetectable levels. I can't see how accepting a possible 50% mortality rate is a reasonable treatment option for 95% of HIV positive individuals.

[Karma]

I know. But eventually even this treatment doesn't work, even if it can take many years.

 

Anyways, it's not like it's really an option for a treatment now. It's only a hope for an option of a treatment which didn't exist before. I actually find pretty amazing that it's actually possible to cure HIV today and not just keep the virus at undetectable levels.

[The Law]

HAART can - and often does - reduce viral load to undetectable levels. I can't see how accepting a possible 50% mortality rate is a reasonable treatment option for 95% of HIV positive individuals.

 

Seconded. Admittedly, haven't read the article as of yet, but given the success of current treatment options at managing viral loads, I doubt this really opens up many doors for most patients. So risky, for something that will be very hard to prove actually works.

[leviathan]

It gives some promise to future genetic treatments against the CCR5 / CXCR4 receptors. They have fusion inhibitors now which block these receptors (enfuvirtide, maraviroc) but I'm not sure if they are any better than the standard drugs.

[xIcewind]

I think this a media sensationalization of this topic.

 

I don't think it is practical.

[cheech10]

http://singularityhub.com/2010/02/26/stem-cell-transplant-defeats-hiv/

there would not be any complication of graft/host i thought...

 

There is definitely a risk of GvHD in any allogeneic stem cell transplant/bone marrow transplant (which is what he had, the usual treatment for leukemia). Autologous transplants on the other hand, as done for lymphoma, have no risk of GvHD.

[blindsideflank]

There is definitely a risk of GvHD in any allogeneic stem cell transplant/bone marrow transplant (which is what he had, the usual treatment for leukemia). Autologous transplants on the other hand, as done for lymphoma, have no risk of GvHD.

 

sorry i meant that i thought the risk would be minimal. well i found some articles on it and you are definatley correct although the morbidity rates seem poorly documented/vary greatly from study to study. but thanks (man i am not a med student and you all can sure make me feel dumb/humbled). thats why i like this forum

 

i thought the cells were taken from the pt, oops had to reread that. wouldnt have made sense to take his cells i guess

[leviathan]

So let's say you're some super-wealth elite who just spawned offspring. Could saving stem cells of theirs in a personalized bank actually be more of a possible cure for any potential HIV they might contract than an allogenic graft?

 

Think about it: autologous transplant has a rejection risk of near zero. The only problem is that HIV is located in other extramedullary sites like the GI tract and brain...so even if the virus is initially eradicated, the latent viruses located in these sites will almost certainly take hold after an unspecified period of time.

 

It's fun to think about though.

 

That wouldn't work because they aren't negative for the fusion receptors, or else they wouldn't get HIV in the first place.

[blaaaax]

It's a neat trick, and inspiring as a proof-of-principle, the rest is just sensationalizing.

 

I believe the rates of developing acute or chronic GVHD are approximately 30% each following transplant (feel free to correct me) and these conditions are nasty. Very nasty. Not to mention a lifetime of immunosuppressants is remarkably similar (probably worse) than living with HIV. As leviathan said what this does mean is that CCR5 is a viable target for eradication of the virus, not just control. Look for gene therapy in the future.

 

I foresee a lot of conspiracy when "Big Pharma" doesn't make this new "cure" available and keeps stringing patients out on ARVs...

[xIcewind]

Want to also throw in the fact that to have a 10/10 (or 9/10) match with dCCR5/dCCR5 mutation for every patient with HIV is impractical. Unless we can artificially source and modify the cells, this will just end up being a case-by-case basis. For those who are lucky enough to find a match, this poses an interesting curative discussion (although the fact that HIV's mutation rate is so high, that it may circumvent and enter via other receptors is a different debate). For the majority of patients with HIV, this is impossible.

[seeking1]

Read into this a little while ago...as a practical treatment, this won't fly. However, it gives some great insight into how HIV works and how to combat it in the future.

[Karma]

It's a neat trick, and inspiring as a proof-of-principle, the rest is just sensationalizing.

 

I believe the rates of developing acute or chronic GVHD are approximately 30% each following transplant (feel free to correct me) and these conditions are nasty. Very nasty. Not to mention a lifetime of immunosuppressants is remarkably similar (probably worse) than living with HIV. As leviathan said what this does mean is that CCR5 is a viable target for eradication of the virus, not just control. Look for gene therapy in the future.

 

I foresee a lot of conspiracy when "Big Pharma" doesn't make this new "cure" available and keeps stringing patients out on ARVs...

 

I agree, There wasn't a whole lot of media cover of this like there should have been. Is it because of Big Pharma? Maybe...

 

I heard that each HIV patient's medication costs 10 000$ a YEAR.

[A-Stark]

I seem to remember a fair amount of media coverage. Where did you hear that?

[Karma]

Well I don't.

[blaaaax]

Seems you misunderstand my post. I wouldn't say there has been too much media coverage, but the significance of this paper is being very overstated in the articles that have been published. This is not a cure, full stop. It is a neat case study demonstrating a cure is not beyond the realm of possibility (one day) building off of this idea. That alone is something special seeing as how pessimistic many of us have become.

 

The potential conspiracy I speak of is what will happen when HIV treatment remains status quo and the crazies start crying out that this "cure" has been suppressed by Big Pharma.

 

Not a cure - not a conspiracy. Period.

[Karma]

lol, why is there always the need to argue about everything anybody says??

 

Nobody said it WAS a cure. It's just good to know that there's a POSSIBILITY of a cure. Gosh

 

And I don't know about you, but I didn't hear about this till I was in med school and I usually keep myself informed of medical news.

[Ubiquitine]

It's pretty well summarize in this article :

 

http://www.radio-canada.ca/nouvelles/sante/2010/12/16/001-vih-leucemie-traitement.shtml

 

Because it's CBC, you probably can acess an english version ( this one is in french )

[leviathan]

Shareholders of major medical corporations do not want stock prices to drop. Said values stay high because of continued dependence on drugs by the general population, and a foolish push by both pharm and doctors to overprescribe medications to the frail elderly.

 

Some of the most profitable drugs in a pharm company's repertoire include antiretroviral therapy and chemotherapy.

 

It's no secret that cure means no more business. Private enterprise has one primary goal - to increase profits. Patient outcomes, and big breakthroughs, are of minimal importance.

 

Academics is no better. Rather than profits, its research throughput that is the yardstick. Innovation is not rewarded nor encouraged - that takes too long and is too expensive. For an example, the discovery of the electron transport chain happened not because of noble academic curiosity, but because the discoverer of this earth-shattering finding was independently wealthy and funded his own research when universities wouldn't.

 

As physicians we will not see cures for our major diseases. We will, instead, see many effective chronic treatments, and a ton of new imaging modalities.

I'm so tired of these conspiracy theories. Think logically about it. The money (and fame) to be found in cures is more enticing than chronic treatment.

[rmorelan]

I'm so tired of these conspiracy theories. Think logically about it. The money (and fame) to be found in cures is more enticing than chronic treatment.

 

yeah, cure AIDS = instant nobel prize = 1,000,000+ USD + return on using the treatment (vastly more) + unlimited grants for the rest of your life.

[NewfieMike]

lol, why is there always the need to argue about everything anybody says??

 

Nobody said it WAS a cure. It's just good to know that there's a POSSIBILITY of a cure. Gosh

 

And I don't know about you, but I didn't hear about this till I was in med school and I usually keep myself informed of medical news.

 

the title of the article did read "Evidence for a cure..."