I love living in the future.

[theweaselking]

Boston doctors duplicate The Berlin Patient, demonstrate a working cure for AIDS in two more cases.

The cure requires a bone marrow transplant and that either the donor or the recipient be HIV-resistant, so it's not exactly the kind of thing that can be widely deployed yet - but it's still awesome.

Comments

[biomekanic.livejournal.com]

Unless I'm badly mistaken (which happens), couldn't they use stem cell cultures and grow out HIV resistant bone marrow lines? I know this'll take time, but it seems to me that it would work.

I know it's not without its issues (i.e.blood typing, etc.), but still, this does seem very promising.

[jerril]

To the best of my knowledge, they aren't able to manufacture bone marrow outside of the human body yet.

Otherwise they'd probably be hunting the hell down every type O- person and trying to develop a broad spectrum of the "most universal" donors available, for the more traditional use in leukemia and lymphoma patients who are unable to self-donate.

What I'm curious about

[disgruntledgrrl.livejournal.com]

Is if after a few years like maybe 8 or 9 - the recipient can produce the same bone marrow.
Thus creating a spreading vaccine.

[fridgepunk.livejournal.com]

Actually this "cure" doesn't require anyone to be HIV-resistant – all it might need is for a complete bone marrow transplant to be undertaken by a HIV+ patient while they remain on anti-HIV medication. That's the hope, as there's no actual reason why the reistance the recipients of the donated tissue had in these two cases was a relevant factor in the remission.

What specifically happened in this case was that:

1) HIV+ AIDS sufferers with mild resistance to HIV in their bone marrow, then had a full bone marrow transplant from fully susceptible donors.

2) the HIV+ transplantees remained on their HIV suppressing medications throughout the transplanting procedure and beyond, which appears to have protected the transplanted tissue from getting infected with HIV.

3) As the HIV couldn't get into the T-Cells in their bone marrow, the HIV infection appears to have died out... at least, while they're on medication that might suppress any evidence of a HIV infection located in sources from other bodily resevoirs (though that's beyond the state of the art in virology; current understanding of HIV indicates that if it's not in the T-Cells and its not in serum then it's not anywhere).

This is notable because with the Berlin Patient, the donor had to be entirely resistant for the bone marrow transplant to make the HIV infection go into remission, in this case the use of common anti-retroviral drugs produced the same effect as the rare immunity, meaning that you should be able to cure any given HIV infection with a very painful and difficult bone marrow transplant plus a common drug regime.

But the new patients haven't been taken off the drug regime that suppressed the HIV during the transplant yet, which means that this could all turn out to be wrong – with the berlin patient, the "cure" effect is produced by the bone marrow itself being immune, while any sort of pico-mole scale retention of the infection will cause the infection to return once the patients are taken off their drugs. So until they've done an assessment of the patients when they're off the drug regime this can't definately be said to be an actual cure.

It also needs a full bone marrow transplant from compatible donors, which are hard to come by (but not as ultra rare as the Berlin Patient's cure was). So it's not a particularly practical treatment that can be employed regularly to HIV+ patients, and it involves long term and consistant use of drugs that are hard to come by in Africa and Asia anyway, meaning that this isn't so much a "Cure for AIDS" as it is a "Rich Man's Cure for AIDS", and it doesn't have any obvious way to develop into a poor man's cure for AIDS unless a method to rapidly and cheaply mass produce cloned bone marrow becomes available (and we're a Space-Elevator-Decade from doing that, expensive and slow bone marrow cloning is a bit closer but still far from done yet, and bone marrow transplants are horrible to suffer through anyway, to the point where if it was anything less than HIV it wouldn't be worth the faff).

On the gripping hand however, given an unlimited supply of donors, universal access to anti-retrovirals and enough surgeons, HIV could end up going the way of Smallpox using this technique.

[theweaselking.livejournal.com]

3) As the HIV couldn't get into the T-Cells in their bone marrow, the HIV infection appears to have died out... at least, while they're on medication that might suppress any evidence of a HIV infection located in sources from other bodily resevoirs (though that's beyond the state of the art in virology; current understanding of HIV indicates that if it's not in the T-Cells and its not in serum then it's not anywhere)

Notably, they pulled stuff out and cultured it in the absence of medication - trying to grow "bits of this dude that aren't medicated" - and got nothing.

But still!

[fridgepunk.livejournal.com]

Yes but the problem with HIV is that it's a provirus, so the standard tests that look for an actual virus will come back negative if it's not currently in its viral form – you have to do a full genomic assay of the patient to ensure the viral genome hasn't lodged some kind of viral cassette inside some random cluster of tissue, and we can't examine patients at that resolution yet. And while generally if it has done that it shouldn't be able to make the switch back to an active virus according to what is currently known about the little fella (herpes can do a similar trick that makes it next to impossible to get rid of, and HIV can do a more sophisticated version of it inside bone marrow but not elsewhere), the possiblity that it might somehow manage to do that can't be easily ruled out and there's no way to really check if it'll do that... except by taking the patients off the medication.

All signs make it look like things are okay, but proviruses are trollface motherfucks in this regard. On the gripping hand we've got a fuck ton of ancient proviral pandemics lodged in our genome as it is, so there no reason even a latent infection will neccesarily lead to remission of the disease.