As Carolyn reported yesterday, doctors in Germany say that they may have cured a patient, Timothy Ray Brown (a 44-year-old American living in Berlin) of HIV infection.
The case study, published in the journal Blood, outlines his treatment. Brown had a form of leukemia and, in addition to chemotherapy and radiation, he needed a bone marrow transplant. So doctors found a donor whose bone marrow contained stem cells with a rare genetic mutation that made them resistent to HIV infection.
The doctors assumed that his even after receiving the transplant with HIV-resistent cells, the infection would return, but after three and a half years, it hasn’t. And he has been off of anti-HIV drugs this whole time.
So he appears to have been “cured” of HIV. But what does this mean for the future of treatment?
The problem here is that to receive the donor cells in the first place, the patient’s entire immune system had to be wiped out. That’s an incredibly risky proposition, Michael Saag, director of Alabama at Birmingham AIDS Center, told CNN.
“Even if somebody doesn’t die from a transplant, there are complications that make it very unpleasant for people to live with,” he said, citing graft-versus-host disease, where the infused donor cells attack the body. In a number of cases, the transplant proves fatal.
Finding a match for a bone marrow donor is also really hard – and in this case, it had to be a match containing the rare genetic mutation that codes for resistence to the infection – only 1% of the Caucasion population (and 0% of the black population) have it.
This is a milestone for HIV research, but more in a theoretical sense, not for practical application.
Still, it’s facinating and no doubt provides a launching point for future research. And it’s been a good year for HIV advances in general – remember that last month researchers reported that healthy men who take antiretroviral drugs are 44 percent less likely to be infected with HIV (even though they were just as exposed as controls). That’s a big step forward for prevention.
I wonder if in our children’s lifetime, they’ll see a change of course in the HIV epidemic (which affects about 33 million worldwide). No doubt our kids’ attitudes and feelings about the disease will be different than ours, because they’re growing up in a world where an HIV positive diagnosis is not a death sentence — many patients now can have normal life expectancies.