Not the cure for AIDS

First off, I want to make it clear I am not by any means saying this man is "cured" however, I don't believe there is any evidence yet suggesting he is not "cured." This article is entitled "Not the Cure for AIDS" yet lays out no proof that this man still has AIDs. Saying that AIDs might be hiding somewhere in this mans body but we have not found it, or saying that this treatment is expensive or risky does not mean there is no cure for AIDs. It merely means that there may have been a discovered cure, further testing will verify, and that there needs to be a easier means of replication discovered for this cure. If the man is indeed HIV negative after all advanced forms of testing, there was indeed a cure for AIDs. Disclaimer: I am by no means an expert in AIDs nor a doctor, merely pointing out the argument that "there was no cure found for AIDs thus far has been flawed" I personally fear that even if there is a cure found that as a society we would reject it.

I remember hearing some time ago that the virus that causes HIV can't survive below a temperature range that wasn't very much cooler than body temperature. Wouldn't cooling a person's body for a short time to below that virus survival limitation kill it off and render them free of the virus?

I'm sure inducing hypothermia would be a risky business, but has it even been tried? Has it been determined how cold a human body can be made to be to the core, and still be successfully re-warmed without excessive risk of death or brain/tissue damage? Can a drug be developed that would cool the body through-and-through to a pre-determined temperature that would coorespond to be lower than the survival limit of the virus and still not kill the patient?

I've never heard of any studies along those lines. Has anyone ever pursued it that line of study?

Thanks...

Thank you for taking the time to clarify this story. While an exciting bit of news, coverage of it completely failed to explain that bone marrow transplant was not a cure or a remote reality for the millions of those living with HIV.

How would someone find out if they have the HIV resistant mutated gene(s) from both parents, so they would know if their marrow might cure someone of Aids/HIV? What gene(s) are they? Perhaps if people knew theirs was the right kind for this, more people would donate?

I would hesitate to blow this case off as a "chance in a milliion" cure for AIDS. This treatment could very well revolutionize the way we treat HIV in the future. To have the potential to cure such a horrible disease is great and exciting. Through gene therapy there may be a way to remove or block the gene that makes people susceptible to HIV. This is just the beginning. I think people who aren't willing to see the future are only blinded by their own ignorance.........

Of Course this is no cure, drug companies don't make any money off cures. That is why it's been so long since our precious drug companies have actually been able to cure anything, even the common cold. You only make money with treatments, not cures and so we will never see a cure to cancer or HIV or AIDS

That is an awesome finding! Maybe this means that we are a step closer to discovering a cure for HIV/AIDS.

As long as researchers and physicians share new developments and continue to sweat for this cause, the cure will be discovered. Remain optimistic that this pandemic will soon be a thing of the past.

I think peoples obsession with sensationalism really pushed this isolated case out of proportion, like the article mentioned there is so many different outliers that could of potential hinder any real conclusion out of this!
It's nice to think that there is a cure found but this does not look to be it.

The number of matching bone marrow donors that are homozygous for the CCR5 mutation is small. However, a person's own bone marrow cells can be treated to artificially create the protective and then be reintroduced into a patients. Site directed zinc-finger nucleases are being developed by companies such as Sangamo which have this capability. Perhaps radiation therapy might not be necessary if someone was implanted with autologous bone marrow stem cells. This however is not a potential cure for the third world but is an important avenue of current research in the HIV/AIDS field.

Thanks for your explanation!! As a medical student, I have been called on to answer this very question for friends.

Researchers and physician have known about this mutation for twelve years so why is it that they don't know EXACTLY what the gene does to confer immunity to the virus? The answer to that question is that anti-viral medicines cost thousands of dollars a month and are a cash cow for the pharmaceutical companies! This story shows that it is possible to transfer that immunity through bone marrow transplants. That is obviously impractical so find another way!!! They should know everything there is to know about what those genes do and how they modify t-cells or what proteins or enzymes they manufacture. Where are the studies to do gene therapy to splice those genes into those without the mutation? Where are the medicines that use the same mechanisms? NIH does very little pure research anymore. Their current study protocols do nothing more than pass out existing medicines to use patients to teach new doctors and not hard science. I know this because I have been a patient there for more than 15 years. Fauci and the others are so cavalier when they talk about what an amazing virus they are up against. HIV has only 13 genes so it's not that complex. Enough excuses already!

It is a compelling report, and clearly represents an avenue for more research, perhaps even a clinical trial.

I would offer this explanation:

The bone marrow from the donor not only was a match for the genes controlling blood type, but also contained the genes which give rise to HIV resistance. Since blood cells as well as the T-cells differentiate from the same hematapoeitic stem cells, the two are at least fundamentally related in origin. Furthermore, there may be modification genes involved in the T-cell specialization that may draw from this homozygous recessive HIV-resistance, which probably leads to the formation of abnormal (but viable) proteins in the cell wall of the T-cell that would, in wild type genotypes, be used for identification by the HIV retroviral vector. Therefore the vector does not recognize the T-cell as what it is.

However this may be confounded if the genes for these proteins are instead expressed in the thymus.

Just offering a slightly technical overview

I'm appalled at the negative outlooks of AIDS experts and doctors on this wonderful breakthrough no matter how seemingly limited the find is seen to be. The AIDS virus plagues our world and any breakthrough no matter how small it may seem should not be taken lightly, especially one of this caliber: doctors may have cured a man of HIV using a bone marrow transplant from someone with a rare genetic mutation. They say this mutation is limited and has limited practical applications - SO WHAT! Doctors can grow skin, make bone, clone mammals and a variety of other revolutionary scientific techniques not feasible when AIDS was first discovered. With all these advancements doctors and AIDS experts should be more optimistic about this find and not place too much emphasis of the limitations.

I'm surprised a story about this particular case was not on the front page of every newspaper in the world. It seems to me American AIDS experts and doctors are upset a German doctor beat them to the punch.

The main point I want to make is this: approach this find, bone marrow transplants of a rare genetic mutation possibly cures AIDS, optimistically not pessimistically.

T. Cooper, 20

WOW, what a wonderful story. I do wonder why only cacusains have the mutated gene that shows resistance. I hope they continue to look at this case and do more research into it. Who knows maybe we are not that far off from a cure for HIV/AIDS.

The chances of finding a bone marrow donor, with two copies of this genetic mutation for everyone one of the 33 million people worldwide living with HIV or AIDS is not realistic because only one percent of Caucasians and zero percent of African-Americans or Asians have this particular genetic mutation

What about the rest of the world?

The answer to the donor problem is to use the patient's own marrow. Remove some marrow, separate the proper cells, and modify them so that they carry the mutation. Put the marrow, with the genetically modified cells, back into the patient. No need to search for a donor match, no chance of rejection, no need for anti-rejection medication.

There is more money in the medicine than in the cure. I think god I don't have this disease. I cringe to think that someone out there has a cure but their greed keeps it from those who need it. I doubt you'd ever hear about a cure being found.

Falco is right........ I would lean more on his first point, they can test it, still not show but be there. During my travels, I was shocked to learn how many people in countrysides of developing countries do not know about the disease. Hope more feedback comes on this issue , remember dec 1 worlds aids day. Daryl from NYC

This needs to be studied, and possibly work on engineering bone marrow that is more resistant to chemotherapy,..then they can attack the AIDS cells more aggressively, and maybe use this in more cases.

Because HIV multiplies in billions everyday in host's body, most probably it can mutate into a strain that successfully may overcome this particular mutation in the host that keeps the virus out of the cells. However, the question is would HIV be able to multiply into that specific strain if the host's genetic mutation prevents the virus' entry into the cells.

I need to add a precision on the subject, the scientists sought did not explain the following: AIDS virus genome integrates infected cells genome and remain forever in the cells 's genome. It can be reactivated after a given time. The article does not say whether retroviral therapy was stopped before testing whether the virus was still there or not, although I have to assume it is the case. By putting the patient through chemotherapy, as the article says, there is a possibility that all infected cells have been destroyed and new uninfected cells develop from the donor and are therefore resistant to AIDS virus infection because of the homozygote resistant gene. That is the reason people called that a cure. There is however another cavea, the fact that bone-marrow transplanted patients are, as the article show, subject to anti-immune drugs to avoid the rejection of the bone marrow transplant. This should favor the reactivation of the virus if there is still some because the patient is defenseless since his immunity is suppressed, but it does not seem to be the case here. There are very sensitive tests that can determine whether the virus is still there or not. Unfortunately, no matter how sensitive the test is, it is extremely difficult to say that the virus is no longer there because one single hidden cell containing the virus is enough to reinfect the whole body should the virus be reactivated. Only time could tell and still. I really believe that this patient, as the German Doctors indicated, should have his case thoroughly investigated. As to Dr.Gallo, I am sorry but he IS NOT one of those that discovered AIDS, those who did so were recently awarded the Noble prize and he was not amongst them. I am not going to get into the huge controversy concerning this point. I really expected the Doctors sought to say that they will be very interested to study this case further and see what they can learn from it, instead of indirectly trying to diminish the importance of the findings. Both Scientists responses was rather disapointing. The truth of the matter is that it is an excellent discovery, that needs to be further studied. A discovery that could be beneficial against many different and specific viral infections and therefore worthy of funding for more work. I wish I could correspond with the scientist who treated this patient.

I have heard of this mutation before. Apparently, it is thought this is a mutation linked to the black plague and why a certain villages survived. I remember reading how many descendants from the villages were tested and a high percentage had this mutation. While not feasible as an application for the entire epidemic, it is indeed exciting. Eventually, one's one cell will be able to be treated to include or emulate this mutation.

This should be on president Obama's adgenda. The people must make them pour money into and research this! There is a cure.

Hi Jackson Russell,

Disclaimer: I'm no doctor.

In answer to your idea about cooling, three things...

1, The virus dies due to low temperatures outside a body. Inside the body, cool temperatures don't kill much. Everything just slows down to a crawl and then, when temp gets low enough, ice crystals form, wreaking all kinds of problems.

2. If even one virus in a billion survives the lowering of the temperature, you'd still here the claim that low temperatures kill HIV. The practical ramifications of that 1 remaining virus is that it would have some trait that enabled it to survive when all of its counterparts died. The virus would come back, but a much higher percentage of the new viruses would be cold-resistant.

3. Finally, HIV is a retro-virus. As I understand that, a retro-virus is particularly deadly because it exists as code that produces the actual virus. That means that even if you eradicate the virus, other cells will continue to manufacture it. This separation between the virus and its producer is what confounds immune systems – they're always looking around for the wrong culprit.

I find it amazing that people seem to think that simply demanding that there be a cure is enough. Would you be willing to try the cure on yourself or a loved one if the testing requirements and research were not done? HIV/AIDS is a serious disease for sure, however look at the strides that have been made so far. Many people are living quite well thanks to the drugs available, and those drugs are making (slowly) their way to the developing world with the help of many dedicated people. I'm not trying to minimize the seriousness of the situation but simply add some perspective.

Most people are clearly missing the point of the article. A cure is something that can be effectively created and received by those with the disease that will eliminate the presence of the disease vector. It is different from a treatment.

Furthermore, assuming that this person is cured of AIDS, which I'm totally willing to believe, it would take a LONG LONG time for this sort of thing to be in a 'cure' form. Bone marrow replacements like this are extremely risky, and there are numerous long term consequences. There are plenty of people out there with AIDS but no bone marrow issues for which this sort of bone marrow replacement could lead to even worse health concerns.

I think that some people are arguing that this opens up a new venue for research, and I totally agree. Scientists agree too. Nothing in this article suggests that scientists are being 'negative' about this 'discovery.' They're being realistic about this specific form of treatment being used as a 'cure' for AIDS. Somewhere down the line, someone might invent a genetic therapy involving a targeted mutation of the 'anti-AIDS' gene. But that's a while from now, and this 'cure' certainly didn't do much to add to the research already being done on the topic.

This is in response to Matt, although I'm not sure he'll read this. By you saying that this is a cure for HIV is splitting hairs. It's a one time thing. Bone Marrow Transplants result in the death of the patient approximately 10% of the time as a result of the transplant, not counting the underlying diseases. Clorox Bleach will eradicate HIV, but we don't go calling that a cure, because it would also kill the host.

No profits in a cure.

I see some very intelligent, thoughtful comments along with some very ignorant, pessimistic comments while reading the remarks to this story.

Firstly, the CCR5-Δ32 mutation has been known to block HIV for DECADES. It was discovered that men in San Francisco in the 1980's who had the CCR5-Δ32 mutation could not be transmitted with HIV, even when 1000 times the amount needed to transmit HIV was transferred into one of their cells. Those of you who think some breakthrough to curing AIDS was JUST discovered in this mutation have a long way to go in terms of your research.

I strongly suggest that those of you who think something amazing has been found to do your research on the CCR5-Δ32 trait, the genetic variant of CCR5, which HIV uses as a co-receptor to enter its target cells. This entire story revolves around the CCR5-Δ32 mutation, which is ONLY found in a small percentage of Caucasians (and mainly in those of Northern European descent). Learn as much as you can about CCR5-Δ32 before you make presumptuous statements regarding the potential future of transplanting bone marrow to cure AIDS.

The basis of this article couldn't be more accurate. Those of who who disagree need to re-read it again and again and then do your research in regard to the aspects you aren't completely familiar with.

And to the pseudo-intellectual "Adam" in the most recent post, much of what you say is incoherent and inaccurate, but most noteworthy is that you remarked that Dr. Gallo didn't discover "AIDS" and that those who "discovered AIDS" won the "Nobel Prize". This article never said that Dr. Gallo discovered AIDS but that he discovered HIV, and there are dozens of doctors credited to both the discovery of HIV and the discovery of AIDS. Those who won the Nobel Prize were simply more fortunate in what patients they came across.

Um, I think people need to remember something. Saying "just mutate the patients own blood" is not something that is really viable here. Really I am not a medical expert. But I know these things are a lot harder then they seem to be when reading them. There isn't a "switch" that you hit on a panel to put mutations in (and not to mention you get crazy complications with mutated blood and stuff like that. If you mess up, suddenly everything goes wrong).

I could imagine turning this into a more widely used cure with the addition of stem cell technology. Take some random somatic cells from a person. Alter the genes to include the beneficial mutation. Use nuclear transplant to generate new stem cells. Induce the stem cells to become bone marrow, and transplant. This should erase the need to find a donor with the mutation and greatly reduce the chance of rejection. Years away and then only available to the rich at first, but still a cure.

In response to the comment from Leigh (Nov 14th) which notes that the article does not explain why bone marrow transplant (BMT) would not be a "realistic" cure for AIDS....there are several answers. First, bone marrow transplantation (BMT) is very expensive therapy that is only available at certain healthcare facilities (i.e. you cant show up to your local hostpial and expect to get a BMT). Second, and probably much more importantly, there are many serious side effects that result from BMT therapy, as evidenced by the fact that it is typically used as second line therpay after a cancer patient has experience a cancer relapse or has not resonded to first line therapy. If BMT therapy were to be "scaled-up" to the level that would be required to treat millions of infected people, there would likey be thousands of individuals who would experience BMT-related morbidity and mortality (ie death). In light of the fact that people with HIV can live long lives with appropriate anti-viral therpay, applicability of any potential cure would require, at least in part, the probablilty of offering minimal treatment-related risk.

You commenters heaping outrage on drug companies don't understand.

They do know exactly how this mutation fights off AIDs, it prevents the Virus particles from recognizing cells that it can infect and then injecting itself.

The problem is that, BMT is not only expensive but it often kills people. You people screaming about money.... those 'greedy' people in the medical profession, if they thought like you claim to do, would proift more handesomely off BMTs for every AIDS patient then current drugs.

Gene therapy, some day, should be able to create this mutation in host cells. But this will not cure AIDs, because all the cells previously infected will still be infected. But at this point gene therapy is a long ways off and very unsafe.

It's always frustrating to hear uninformed and conspiracy theorists try to blame the drug companies for not finding a cure for anything. The most obvious way to negate this is to point out vaccines. If some of you thinking you were smart and "on to" drug companies and used a little common sense you would see that no one is out there intentionally prolonging an illness, and even if you want to talk dollars selling a cure is better than giving nothing, or letting another company sell their antiretrovirals. If the cold is so easy too, why don't you get find a cure for it.

I wonder if it would be possible to clone the resistant bone marrow with stem cells?

Even if this is an isolated case, so what! Yes, there are a small percentage of Europeans and North Americans (with European descent) who are homozygous for the delta 32 deletion. At least this case offers hope, and some hope of a cure, surely some hope is better than no hope. Would it not be a good idea to ask people to go for genetic testing to find out if they are homozyygous for the delta 32 deletion? If there is a way that we can help save peoples lives, then I say let's go for it, even if it is a long shot.

Considering the implications, shouldn't the "more sophisticated tests" be done ASAP? Has the patient in question refused this? I assume someone wants to dig deeper into this.

Although it would not be possible to find many marrow donors that have the specific genetic material as this person received, it might be possible to develop this marrow through adult stem cells (adult stem cells come from one's own body, not embryos, so it elimates ethical problems). Instead of just brishing this case a simply "farce", we should investigate it further and hold great hope that this is the right pathway to a cure. Sometimes a outside thinking doctor and some simple luck can produce a cure. I do not believe this approach has been used before, but it is a case like this can change our direction on AIDS/HIV that can lead us in the right direction. I pray this may lead us to a cure to eliminate this horrible disease.

thanks,
Jon
Minnesota

The virus integrates itself into the human genome. Everything has to be perfect in order to kill the virus while saving a human being during a transplant. Not a single infected T-cell or macrophage can survive. This individual was lucky.

As was said previously, marrow transplants are a risky procedure with 20% of individuals dying during the process. You're still talking about 6.6 million people or more that will die. The numbers will be far greater in third world countries.

Not a cure by any means, but it does look hopeful in terms of another possibility in the future.

Criticize all you want, but this is hopefully a step towards curing rather than treating symptoms of HIV.

What people need to also realize about the 1% who's immune system HIV cannot attack is that they STILL CAN BE carriers of the virus, they just will not develop AIDS. That means they still can carry and infect other people.

I guess I would have to stress that bone marrow transplants (BMT) would have to be the absolute last resort for people with AIDS. I have had the unfortunate experience to have been in a BMT unit for quite some time while supporting a friend and not only are they horrible to go through, but many, many people do not survive them. IF a virus/bacteria/fungus does not kill you while your immune system is gone/weakened, and IF your new bone marrow actually starts producing and IF your old cells don't come back with a vengeance and IF you survive "acute" graft vs. host disease (most often in the skin or gut, in which your intestines kind of slough off from the inside.... its a nightmare) and IF you don't get "chronic" graft-vs. host disease and IF your new immune system thrives enough that you can fight off viruses that attack years later.... then you might be OK. The BMT doctor explained all this to my friends saying, "If you are not crying with fear by the end of this talk, then I haven't explained a bone marrow transplant well enough." It is survivable... but make no mistake... it is a beast.

"I remember hearing some time ago that the virus that causes HIV can’t survive below a temperature range that wasn’t very much cooler than body temperature. Wouldn’t cooling a person’s body for a short time to below that virus survival limitation kill it off and render them free of the virus? "

While it could possibly kill off the virus it wouldn't kill off the virus' "offspring." I don't know if they have tried this but I do know that a virus replicates itself by injecting its nucleic acid (DNA/RNA) into a host cell. While this nucleic acid begins to mature it is maturing inside the cell until eventually the cell bursts open releasing multiple viruses. So, while hypothermia may work (again I have no idea if this has been tried) it wouldn't kill off the human's own cells that are harboring the maturing virus.

Of interest is the frequency quoted for the prevalence of the CCR5 mutation in Caucasian populations and its complete lack in other populations. One other organism also uses the CCR5 receptor for entry and that is Yesrsinia pestis aka the plague. A speculative paper published some time ago put forth the theory that natural selection during the Black Plague and subsequent plagues drove the selection of this mutation.

One (of many) potential difficulties with pursuing this avenue is the fact that there is actually another co-receptor which is used by some subtypes of HIV, CXCR4, and this subtype is often found in later stage AIDS patients. So a blockade of CCR5, whether by drugs or by marrow transplant, may not provide complete immunity.

Nevertheless, this is an interesting finding and one that deserves further study, even though the immediate applications may not be apparent at this time.

While very promising to future research, this method is unfortunately not adaptable in large scale treatment. This man was very lucky in that the normal number of compatible donors is 1-5 people. They found 80. This guy already had 16 to 80 times better probability of marrow transplant compatibility than the average person. Many people can't even find a compatible marrow donor.

Never in my 26 years living “healthy,” with HIV has there been as much advancement in education, research and phenomenal medical data regarding this disease. Those of us who obviously are well aware of the daily mutating and challenging remarkable discovery’s; welcome this news, this is what so many with HIV/AIDS living and sadly past have waited for all these years, “Medical advancements in AIDS is moving forward,” for this we can be assured our voices have been heard, that funding, donations to assist within to the scientific community around the world are being used to find the imperative “answers and discoveries,” while not spending their weekends at luxury spa resorts. I personally thank you for your years of dedication to your work and discoveries; one day millions will be able to rest peacefully knowing it’s over; as was polio at this rate.

One snag in this procedure that appeared in other reporting: the patient was given a 20% chance of dying from the pre-operation treatment to suppress his immune system so that the transplant could succeed. Even if cost were not an issue, having one in five patients die during treatment is a risk doctors would not want to take for patients that are not in imminent danger. The importance of this discovery is not that one man many have been cured (only time and observation will confirm that) but that it opens new avenues for research, a point that has been marginalized in much of the media coverage.

I believe that pharmaceutical companies reap vast rewards from treatment, vice the production of cures for a number of diseases – as some folks have already written. I've also read that cures for some incredibly rare diseases do exist, but because the "demand" for these treatments is so miniscule, the cure is rendered too expensive for anyone, including the pharmaceutical companies, to afford. Some people believe that socialized medicine will cure this issue in and of itself. To that, I ask that the folks of this mindset review previously reported stories regarding Walter Reed Hospital. As a Veteran, myself, I'm here to tell you that Walter Reed is only one drop in a very full bucket. Socialized medicine has always existed in the military, and though it's an obvious necessity in such a venue, overall, it doesn't work very well at all. Nor does it create the wealth that is required to develop cures for many "cure-resistant" diseases. Secondly, though the individual in this report may indeed soon be heralded as the ice-breaker for a new generation of treatment, there is no cure for AIDS. The fact is, AIDS mutates so readily and so consistently that it has rendered most previous forms of treatment obsolete within a very short period of time. One day, a viable cure may be found. In the meantime, taking a little care of yourselves (and curbing risky behavior) shall remain the best "cure" of all – and for us all.

It is interesting that they had to zap his immune system with chemo prior to the marrow transplant, and HIV lives and hides in immune cells.

Is it possible that the result may not have been solely due to the marrow transplant?

Thank you for the interesting artircle. We just covered HIV in medical school and unfortunately this case was only mentioned briefly in our lectures.

As mentioned in the article, this virus can hide very well and may reactivate, but even if this treatment is not successful, it is another step in the right direction.

Angry in DC (and others interested);
It is known why the Delta32 mutation confers HIV resistance. People with this mutation lack a key coreceptor on their T-Cell surfaces (called CCR5). Without this receptor, the HIV virus cannot get in to the T-Cell, and, if it can't get in, it cannot destroy the immune cell and it cannot replicate. There are actually drugs that block this receptor (Maraviroc and others in clinical trials. Actually, entry inhibition is a hot topic of research (I work in this area). There is another entry inhibitor, Fuzeon, that works quite well but costs (as of 2 years ago) $25,000 per year per patient.
The problem with this finding and CCR5 inhibitors is that they only prevent viral entry for viruses that use this coreceptor, while there is another coreceptor that some viruses use; CXCR4. Fortunately for those in Europe, North America, and most of Asia, the HIV virus that is circulating uses CCR5. But where HIV/AIDS is most damaging, Africa, many viruses use CXCR4 or both receptors to enter cells. And, given enough pressure, the CCR5 virons can mutate to use R4. Why not figure out how to block CXCR4 then? Well, unlike CCR5, knock-out mice lacking CXCR4 type receptors die very quickly if they make it into life. We would probably be the same and be super-immunocomprimised if CXCR4 was blocked or lacking.
The "good" news are there are other ways to prevent HIV entry (go wiki HIV entry inhibitors), and, as this patient suggests, if you can keep HIV from getting in to a person's T-cells, the virus will eventually be suppressed.

Contracting AIDS is preventable, unlike many other diseases.

This is one of the best medical reads in a long time.....HIV is wiping out populations..and this generation is dealing with it in GI-NORMOUS numbers...I truly believe there is a cure out there somewhere....to those living with the Virus...stay strong...to those not, try to reach out...K, I'm done:-)

I think there are cures existing today for many of the cancers and even Aids but the so called people in charge, at the top, are not willing to lose all the money being made on the many sick people dependent on thier daily meds and doctors visits at this time...

Some thoughts/clarifications...
1. The CCR5 gene prevents the virus from entering and infecting cells. Since most of the virus lives within cells and must be within the cell to propagate itself (using reverse transcriptase), blocking out the virus is preventative of infection.

2. I don't like the "conspiracy theory" that drug companies only look to develop treatments, but not cures. The common cold was noted - the is no treatment for the common cold!!! All the cold medicines you buy in stores are to decrease the symptoms, but do not affect the virus.

Moreover, a drug company would LOVE to be the one to develop the cure. Not only is there lots of money in the cure, not only would it bring lots publicity and respect for the drug company, but it is the a humane act! Drug companies make most of their money on drugs increasing sexual activity (e.g. viagra/cialis).

3. Regarding this story... bone marrow transplantation is like trading one disease (i.e. cancer) for another. Life with any organ transplantation requires lifelong adherence to a medical immunosuppressive regimen, morbidity associated with the above, and frequent monitoring for rejection of the transplant as well as the transplanted cells rejecting your body (graft vs. host disease).

4. Lastly, it is silly to say that this patient would "have died from cancer, not HIV/AIDS if he didn't get the transplant." The HIV virus itself is NOT the direct cause of death in HIV patients. They die because their bodies are overwhelmed by infections and cancers they become susceptible to as a result of an ineffective immune system. Yes - your immune system fights many cancers!

5. While the story is very interesting, it is impractical as a solution.... you could just as easily say "moving all HIV/AIDS patients to an island cures AIDS" or "banning sexual intercourse and IV drug use is the cure for AIDS." I think we will be stuck with AIDS for many years to come. I hope you take appropriate actions to prevent disease transmission - a practical cure is a long ways off!

Initially it was thought that Caucasians who are descendants of those individuals surviving the Bubonic plague during the Dark Ages carries the genes for resistance to HIV because these are the same genes that protected the survivors from black plague during the Dark Ages. Now however, it is thought that smallpox served as the selected pressure against which the CCR-5 gene was selected for in the Northern European population.

As a graduate student in the science field, I want to let readers know that millions of dollars in NIH money and external funds are dedicated to AIDS research, more so than research done on study of of other diseases besides heart disease. Please, leave out the corporations–it's always easy to villify a corporation, but they supply jobs and contribute to the economy. It's always very disheartening to hear people talk about how easy it is to look for something, but the big bad corporation prevents this from happening...no. it doesn't work that way. Every year researchers gather and discuss their progress in HIV vaccines, mechanism of pathogenesis etc. There is a giant force working on HIV and no simple cure will be discovered soon. All we can do is understand how we can attack this virus without affecting the host. Trust me, scientists are competitive and critical...if there was something simple out there, it we would have either found it or found some flaw in it.

I am a scientist who studies HIV at a top tier research university.
No one is trying to diminish this finding. The reason to word articles carefully in the manner of this one is to make sure people who have this disease do not get unrealistic expectations. This isn't in an attempt to kill anyone's party. People who study this disease work hard every day to bring about change. I would love to find a cure that would work for people of all nations and socioeconomic status, and that is what my lab is working toward.

You can be a cynic if you want to, but that won't stop me from going to work tomorrow and continuing to do what I have been doing for years, trying to find a cure. And if I find one, you can bet I will publish it and it will be given peer review and it will get out there. I am a decent, hard working person who believes very much in what I do. I am tired of scientists being villified as people who are just out to make money, or who have some weird vested interest in making sure a cure is hidden from the world. Nothing could be farther from the truth.

Bone marrow transplants for AIDS patients with cancer were tried nearly 20 years ago at Johns Hopkins and the HIV came back after recovery from the transplant. It could not be eradicated because it hides out and can come back later. I don't know if the work was published because it was not felt to be a success at the time.

Matt – I believe what the author means to imply is that this is not a cure for the aids epidemic. You're right in that it does, in fact, appear to be a "cure" in the sense of it will rid an individual of the virus, but– the author is trying to point out this is not a feasible solution for the vast majority of people who have aids...specifically, those who are living in 3rd world countries. I suspect that the author is worried that the media hype-machine will jump on this and proclaim that a cure for aids has been found, and then those who are most suffering from the disease (again, those in 3rd world countries) will be abandoned.

I hope that made sense...

Funny that Gallo is offering his expert vision on this. He is one that profiteered of the AiDS crisis in the 80s with a rush for the isolationtion of the virus. It has always been about money, not helping people.

Furthermore, it is pretty well known that stem cell therapy can theoretically cure HIV infections which is the core content of Bone Marrow. Now that we can harvest stem cells more efficiently besides gettting them from aborted babies we can genetically teach the immune system to not allow the HIV infection to spread. Now that we have a new president who is coming on who supports Stem Cell research I am very confident that we will be seeing medical revoulution in the next 10 yrs.

Stem Cell therapy is a bigger than the discovery of Penecillan.

But Morbius is right... there is no profit in a cure. Sad sad world.

Please understand that doctors are being pessimistic about this “cure” for a reason. The number of variables involved with this type of treatment are truly staggering. The human immune system is incredibly complex. Your body accumulates information on every disease you encounter and then build a “database” of appropriate responses (antibodies and immune cells) to the given infection. It does this by identifying the cells that belong to you (self/host) from any other cells that may enter your body. These cells are created in the bone marrow.

Simply finding a bone marrow match for a transplant is really amazing. A “normal” transplant requires that the donor organ’s cells (i.e. kidney, lung, liver, etc…) look enough like the host’s cells that the host’s immune system will not identify it and start attack on the new organ.

A bone marrow transplant is much more complex. It is like taking a bunch of aggressive guard dogs out of their house and putting them in a similar house with a new family that looks similar, but is not exactly the same. You just pray that none of the guard dogs figure out that couch is supposed to be blue, not green. If they do, things go to hell really fast. Why? The donor’s cells must be similar enough to yours that their bone marrow will not start producing antibodies to your cells. If the match is not correct, the donor’s bone marrow will begin producing immune cells to anything it does not recognize. It is called graft vs. host disease and it is the reason why those with transplants are required to take immunosuppressant medications.

Now, this is just the complexity of a transplant. Imaging adding virus as devious as HIV to this organized chaos. You can see why the doctors treating this patient were a little surprised to see that it worked. Keep in mind that none of the doctors are claiming that this patient was completely cured. The reason why? HIV is retrovirus and can lay dormant for years before raising its ugly head. What is a retrovirus? That means it has the ability to invade your cells and integrate its DNA into your DNA. It literally becomes part of you at the very most basic level. The only way to get rid of the viral DNA is to destroy the host DNA. If you destroy the host DNA, you kill the cell.

This man is truly blessed and a miracle. I know he will be studied throughout the world and hopefully. I have given a very simplistic explanation about a very, very complex subject. I hope you can see why doctors and researchers may sound pessimistic.

To Josh...drug companies have nothing to do with BMT. Also, without them millions more would die from disease. Since 2006, drug companies have spent over 96 billion on research for new compounds.

Also, for anyone that knows about BMT, the mortality rate is more than 25%. It's not an easy decision to make. The graft versus host disease alone can be brutal.

Any doctor or institution that would hurry this research along, would be the first one you would sue if things didn't work out.

I am not sure that chemotherapy would eradicate CD4+ microglia cells infected with HIV.

You all are really tripping if you are so educated, Please go to school and become a scientist or an AIDS expert so that this can finally end.

Im sure those that suffer with this disease can care less about hearing your opinions. If you're not an expert please stop knocking the ones that are actually trying to discover something.

And enough on knocking the drug stores; If its something out there that can make a person feel a little better then maybe to that person its worth thousands of dollars!!

I've heard that the technology of medically inducing a fever kills cancer cells in a person in Germany. Its been around for more than 20 years (I'm not revealing sources because thats inconsequential concerning the bigger picture). So I say are any of these "experts" here in America going to go to Germany and see first hand what it is that the these medical practitioners have discovered, stumbled upon, partially revealed....Whatever!! Or are we supposed to be content that AIDS is still incurable and we're going to see more deaths due to the strangest virus in the history of human kind (down to certain demographics of people being more succeptable than others). Come on guys we've been sending people to the moon for 38-39 years, embarked upon stem cell technology, theres techtonic warfare technology available for the most powerful (richest!) governments and we still can't cure AIDS??? The American Medical Association and all the leading Pharmceutical companies around the globe are full of shatola, no cream or sugar necessary. Oh by the way, did I forget to mention that AIDS is most prominent in Africa, with new (stronger) strains in Asia!? Well thats what I read about Asian strains (years ago). Is that also not true? I obviously don't have alot of faith in American Medicine as you can tell. Show us all something, damn it all!!! Thats why I don't have any faith. Can you blame me.

I read these conspiracy comments with a mix of disgust and mirth. On one hand it is disgusting for people to think (and keep spamming the comment board) that, "oh all drug companies are evil man, they just want money man." However, at the same time it is so funny to think that people believe these things. If there was no money in a cure then why would we have vaccines to prevent pollio, why would we have chemotheropy, and why would we have antibiotics?

Now on the topic of the article. It is very interesting that this might a way to cure or at least delay the growth and spread of the HIV virus. However, it is obvious that this will never be a reasonable way to stop the aids epidemic.

-Josh

The author makes a great point that MANY times people with HIV taking anti-retroviral drugs will later be tested and come up negative for HIV. The problem is that the tests for HIV (and many viruses for that matter) are not yet sensitive enough to detect low, but still threatening, levels of many viruses including HIV.

This looks like a promising step forward for RESEARCH, but I think the author is correct saying this cannot be considered a cure, especially because it has not undergone true scientific testing yet: it is not even remotely scientifically accurate to call something a cure off of a single case study.

A Bone Marrow Transplant is not a practical solution to treat AIDS for many reasons including toxicity. However, this case report is important because it shows that if an infected patient's T-cells can be replaced with T-cells harboring the CCR5-Δ32 mutation, that the HIV virus can be functionally suppressed without anti retroviral drugs. What has not yet been mentioned is that a clinical trial further testing this hypothesis will hopefully be initiated at the U of Pennsylvania by Dr Carl June later this year. He has proposed removing a patient's own T-cells and modifying them with a technology called zinc-finger nucleases. These modified T-cells then become functionally similar to those from individuals with the inheritied the CCR5-Δ32 mutation. The cells can then be infused back into the patient. When this experiment is performed in HIV infected mice, the infused T-cells selectively survive and expand and produce an effective immune response against the HIV virus. This case report certainly supports the rationale for this kind of approach.

This article inspired me to be a bone marrow donor. Not because I think I can be one of those people who have those rare gens but because I realize I can help someone. I went to the National Bone Marrow Program website and I found out that in order to be a donor I must cover a $52.00 fee. It's a shame that that fee keeps me from being a donor as I'm not able to afford it... I think we should start from there, make bone marrow donations be available to low income people like me. I have friends who have the HIV virus and if I could help them and anyone living with this decease I would.

I read about this finding earlier this month in another national paper. They reported that in 1989 another cancer patient who was HIV positive also had a bone marrow transplant, which appeared to clear his body of HIV. Unfortunately, the patient died 47 days after the BMT. However, his autopsy showed no sign of HIV in his internal organs, which is one place they are concerned the reservoirs of dormant virus may be hiding. Hopefully we will find a curative treatment based on this new area of research surrounding CCR5.

When I first heard news of this "cure," I immediately thought of Dr. Gupta's first point: current tests are only so sensitive. I'm currently pursuing combined medical and graduate degrees (the PhD is in molecular biology), and what I typically hear doctors say around the hospital is that the reason patients go into cancer remission and then relapse is that those cancerous cells are never completely gone, just present at such low levels that we cannot detect them. With regards to the the idea of chilling people to cure HIV, I suspect that it would not work. I did a very quick literature search, and could not find any indication that anyone has shown cold temperatures to negatively impact the virus. On top of that, it is common practice in laboratories to store things (cells, viruses, etc.) at temps from 4 degrees all the way down to -80 degrees–way too cold for human survival. We later thaw these things and continue studying them as if they'd never been frozen, as it seems to have little effect once they're brought back to room or body temperature.

"Jackson Russell November 14th, 2008 7:24 pm ET

I remember hearing some time ago that the virus that causes HIV can’t survive below a temperature range that wasn’t very much cooler than body temperature. Wouldn’t cooling a person’s body for a short time to below that virus survival limitation kill it off and render them free of the virus?

I’m sure inducing hypothermia would be a risky business, but has it even been tried? Has it been determined how cold a human body can be made to be to the core, and still be successfully re-warmed without excessive risk of death or brain/tissue damage? Can a drug be developed that would cool the body through-and-through to a pre-determined temperature that would coorespond to be lower than the survival limit of the virus and still not kill the patient?

I’ve never heard of any studies along those lines. Has anyone ever pursued it that line of study?

Thanks…"

Such tests have been done. The Nazi scientists testing on the people of the holocaust.

Matt, with all do respect, you clearly have no idea what you are talking about. You clearly have no idea how science works. Just because something happened to have worked in one case under certain circumstances does not in any way make this a "cure" for aids. The word "cure" denotes have a treatment which has been shown to work in essentially all cases–it is bulletproof, a real CURE. This is not that at all. You say "Saying that AIDs might be hiding somewhere in this mans body but we have not found it, or saying that this treatment is expensive or risky does not mean there is no cure for AIDs." Yes, it does. It's not like we've stumbled upon an unknown treatment. Scientists have known about CCR5 for a while now. Bone marrow transplants are extremely risky and dangerous, and the odds of finding a match which is ALSO a homozygote for this mutation is unlikely–which makes its application as a TREATMENT dubious, let alone a CURE...if you had actually READ the article you would understand this. Do some reading before you post something foolish like that.

So what if the bone marrow transplant has a 20% chance of killing the patient? AIDS has a 100% chance. This gives hope to people where hope did not exist before. Of course this should be considered an option!

As an American Registered Nurse working on the front lines of the HIV pandemic in rural Tanzania, this article and the attention it brings to the problem is wonderful news to my ears. Our region lies where highways from Malawi, South Africa, Zimbabwe, and the port city of Dar es Salaam collide. Our estimated HIV rates are estimated at above 15%. I am thankful that there are intelligent and compassionate people all over the world dedicating their lives to alleviating the suffering caused by this horrible virus.

However, I cringe to read some of the above bloggers saying that all we need to do is dump more money and effort into "curing" this problem. Billions and billions of aid dollars come pouring into this country every day. We have store rooms full of ARV medications and it is thanks to our American tax dollars and the generous donations from Germany and other countries. It is wonderful to see a patient with a CD4 count of 3, soar to 310 after beginning ARVs. Yet, there is so much room for improvement. Billions of dollars are being siphoned into the pockets of federal government leaders, ward officers, and village leaders – relatively very little of it lands in the hands of those who need it the most. It is time governments reduce their "money dumping" into programs and ideas and begin investing them into people getting their hands dirty on the front lines. Also, until we first fix the problem of poverty, we cannot expect young ladies to stop selling their bodies for a few shillings, just so they can survive. Their will be no eradication as long as the question remains, "Do I risk getting HIV and dying in 10 years or avoid the risk of getting HIV and die this month from starvation?"

I think this is a positive step in the right direction. it at least gives us some hope for the future of mankind and particularly us in sub-Saharan Africa.i hope the worlds greatest minds will come together and explore more options through this path.

I had the chance to know a lovely young lady in Atlanta with AIDS 16 years ago. This woman underwent a bone marrow transplant at one of the best hospitals without much success. When it came time to have a second one, she declined it and then subsequently the drugs that were sustaining her. Why? The bone transplant was so painful, and in her state, she could hardly bear the first one carried out in her hip. Granted, this person had AIDS, not HIV, but at times the "cure" is worse than the option to die. I miss my friend; she never had the chance to live, marry, have children. (Yes, she was a heterosexual female.) I'm glad advances are still being made, and hope that funding continues to fight this horrible disease.

I agree that a bone marrow transplant is not the ideal, but maybe we can use stem cells to and create bone marrow cells that carry the gene that makes cells resistant to HIV along with their histocompability and put them in a person with HIV. I think there is a lot to be learned here that could potentially lead to a cure.

In response first off, I completely agree with the notion that this either "treatment" or cure, whatever one cares to argue for, is by no means the final verdict. Neither the article nor I suggested that. On the contrary the article explains that this cannot be applied universally and I accept that as fact
This finding isn't the answer for everyone. But it better be the start of a serious consideration on how to go about discovering the "final verdict" on HIV/AIDS. I believe the path to a cure may have been the major discovery here. I dare the medical community to set a goal for investigating and perfecting this path in the near future, not the upcoming decades. Be it Stem Cell Research or some other means of introducing this “new immune system” giving our body the knowledge on fighting AIDS with its own immune system and using this rare genetic key, perhaps through a cloning mechanism or by engineering ones own cells, this is what we need to investigate. I for one don’t understand the linguistics of these processes, as I am not a doctor.
In a final conclusion I have this to say about the article. I agree with the notion that AIDS is by no means a mystery solved, or an ailment of the past. I disagree that this "cure" is not applicable for anyone, obviously the patent who is living today can attest to that. . Certainly he can argue that this finding must have some immediate use for others in the stage of experimental therapies, perhaps others with both Leukemia and HIV/AIDS and without the promise of a long future of antiviral drugs; may for those in the more desperate stages of AIDS. These people certainly can argue that this is a fair chance on extending their life, regardless of the risk. Where is the ethics in telling these people: “This is interesting but not a practical application. It’s not feasible..."
You cannot ignore the fact that it was indeed a cure (thus far) for one man, and possible hundreds if not thousands of others. A man took an experimental treatment in order to live, and he won, an astonishing victory for the world. This is the message the article needed to convey, but instead mitigated any progress made. I cannot end this comment without saying to all who are in a position in the medical field to make a impact on this finding, DO NOT DISMISS IT, IMPROVE IT. We cannot dwell on pessimism surely the light bulb wasn't perfect when it first lit up a room, and that was after hundreds of trials; further more at that time most homes didn't even have electricity; but we don't use candles today, and we will not be using inconstant bulbs tomorrow. Please in further posts argue not what I wrote but that point, where do we go from here after this historic turning point in the fight for that final verdict, the cure EVERYONE has hoped for, the death of AIDS domestically and abroad.

I am not sure if this is a "cure" but I do believe that they should test this theory out on another willing HIV patient. I think that automatically claiming that it is NOT a cure is not fair to those who so desperately want a cure. But, we all have to remember, the money is not in the cure...it is in the disease. If doctors cured HIV, they millions of dollars that they make off of treatments and medications would go down.

I stand corrected. Here is an abstract from 1989 describing the earlier experience of bone marrow transplantation in a patient with lymphoma (Dr. Saral moved to Emory a few years ago and is still there):

Allogenic bone marrow transplantation (BMT) plus azidothymidine (AZT) in an AIDS patient with non-Hodgkin's lymphoma (NHL).

Holland HK, Rossi JJ, Donnenberg AD, Zaia JA, Santos GW, Saral R; International Conference on AIDS.

Int Conf AIDS. 1989 Jun 4-9; 5: 405 (abstract no. W.B.P.319).
The Johns Hopkins University, Baltimore, MD, USA

OBJECTIVE: To evaluate the effect of combined modality therapy (AZT plus allogeneic BMT) on HIV-1 infection in a lymphoma patient with AIDS. METHODS: The patient, a 41 yo HIV-1 culture+ man with NHL, received cyclophosphamide and total body irradiation to ablate tumor, bone marrow and marrow derived cells. AZT (5 mg/kg q 4h) was begun 2 wks prior to BMT. Nine days after initiation of ablative therapy he received 4×10(8) nucleated BM cells/kg from his HLA identical sister. At this time AZT was reduced to 1.3 mg/kg q 4h and maintained at that level for the duration of treatment. HIV-1 was monitored by culture and polymerase chain reaction gene amplification (PCR, LTR and ENV, DNA and reverse transcribed RNA). RESULTS: Despite continuous AZT, engraftment was prompt (17 days to neutrophils greater than 500/mm3). Peripheral blood mononuclear cells and BM samples became HIV-1 negative by culture and PCR 32 days after BMT. The patient died of tumor relapse 47 days after BMT. Complete autopsy showed no evidence of HIV-1 by PCR (brain, BM, spleen, tumor, heart, kidney, liver, lung, colon) or culture (brain, BM, lymph node, tumor). CONCLUSIONS: 1) The patient tolerated intensive therapy associated with BMT 2) Prompt engraftment was attained despite AZT therapy 3) PCR and culture data suggest clearance of host cells harboring virus and prevention of infection of repopulating donor cells.

I think this is a great achievement in medicine and with a little additional research disastrous diseases such as AIDS and cancer will be cured.
Nelly

Read Jacquelyne Froebers article on Health.com. It clears up some confusion on stem cell bone marrow transplants for HIV.Keep up the research.

2 QUESTIONS:

1 . Why can't THOSE IN DOUBT just go ahead and clarify the existence of hiv on the man's body using their advanced/sophisticated hiv testing kits and see whether traces of the virus still exist in his body? -and get back to us(instead of the issue lingering on in some seemingly perpetual undetermined state as is presently the case).

2. Why dont we just embrace stem-cell research as the FUTURE and probably the best shot to finding many cures for the many long-term ailments? -diabetes2,hiv/aids,cancer the list is endless ...(since evidently, much -almost everything is been tried "mainstream" without much promise or even success...its like looking for the cure in the wrong place when we have a better shot that is staring at us in the eye- infact! not doing this means we are delaying the cures and yes at our own life-expense).

Concluding...though the issue of "life beginning at conception" remains and abounds(on stem-cell research et all) but even the kids who are now being born will bear the same burden we bear today- question is when will we decide to attack these diseases with all we have...coz at the moment "they" are attacking us with all they have and are ahead at it.

Matt-

First of all, we need to be clear about something. HIV is a virus, and AIDS is a condition that results from being infected with the virus. If you can't get your terminology correct, you can't have intelligent discussion about the subject.

The point of this article is to serve as the voice of reason. Dr. Gupta isn't being an uber pessimist by posting this, he's telling you what the initial reports should've told you. This is not a cure. I might only be a Ph.D. student researching human retroviruses, but even I could have told you this.

Hope is out there, but it isn't in this case.

My husband died from complications of a bone marrow transplant. He also had Acute Leukemia (ALL), he did not have AIDS/HIV. To say it is a cure is a hilarious statement. Although my husband died of complications from a transplant, he still really died of ALL. You can put any kind of spin on it you like, but a BMT is NOT the way to 'cure' AIDS. First of all you have to go through all the chemo which can cause cancer later, possible radiation chemo, etc.; then you have a 25% chance of a major organs failing right off the bat from the transplant alone. Then there are the 'side effects'. My husband had Graft VS host disease and then developed all sorts of problems, which eventually led to his death only 6 months after the transplant.

I think it is wonderful that this worked for this guy, but as most of the doctors said, it is good case for research.

Matt, I disagree with your feelings about a cure and society rejecting it if it was there... the doctors we had really did want to see a cure, I know that it is hard for them to see people dieing in their care. They feel frustrated and helpless, just like we do.
thanks for reading.

We will have a cure in the near future. I know how hard the scientist are working. If you get the HIV virus take you medicines get your hep shots both A and B. If you get it from a boyfriend that was not faithful to you. Remember to be careful and not to get into that situation again and please don't spread it around. You can live a long and healthy life even with the virus. Do not aggrivate the situation by continuing un-safe practices. Remember you will survive and you will pull through. You must have faith in yourself and faith that in your life time we will make a break through and it will happen . We even might be surprised that it might be something very simple that we didn't even think of. What about BMP

With as much as they know about the HIV, I wonder why is there no cure or vaccine for it? I do believe that drug companies don't want cures so that they can continue to make money, but I don't believe that every single person that would know about them doing that would keep quiet quiet while millions of people are suffering and dying from diseases. If I knew, I wouldn't care if they threatened to fire me, I would go public with it.