By Miriam Falco
CNN Medical Managing Editor

A German hospital announced this week that a 42-year old American living in Berlin who did not want to be identified had come to them three years ago for treatment. It was determined that he had acute leukemia (blood cancer) and was HIV positive too.

After a bone marrow transplant, it appears that not only did the man’s cancer go away, so did the virus that causes AIDS.  This has been reported worldwide as a “cure” for AIDS. But even the doctors involved in this case say they don’t know if they cured this man of HIV.  So what’s all the fuss about? Should HIV patients be treated with a bone marrow transplant?

One of America’s top AIDS expert doesn’t think so. “This is interesting but not a practical application. It’s not feasible and has extraordinarily limited practical application” long-time AIDS researcher and Director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci told CNN.  He and other researchers first learned of this case back in February. But this study of one patient has not yet been published or been reviewed by other AIDS experts. It didn’t get much attention back then because of the many limitations it has.  Dr. Robert Gallo is one of the scientists who discovered HIV. “While this procedure might help a very small minority of people living with AIDS,” Gallo says, “it is by no means the answer to the world’s HIV/AIDS pandemic.”

Doctors first began treating the cancer with chemotherapy. They also gave him anti-retrovirals to contain the virus that causes AIDS. Doctors said at a press conference this week that the patient did go into remission, but eventually the cancer came back. The next step to treat the cancer was a bone marrow transplant, which is common for leukemia patients.

His doctors emphasized that without further treatment, without the bone marrow transplant, he would have died of cancer - not HIV or AIDS.

But the patient’s physician, Dr. Gero Huetter, wanted to combine the cancer treatment with something he had heard about in medical school 12 years ago. That’s when researchers found out that a certain genetic mutation prevents the virus from getting into a person’s cells. But to be resistant to HIV, one has to have inherited this mutation from both parents.

So when it came to looking for a bone marrow donor for his patient, Huetter decided to see if he could find a donor that not only was a marrow match for his patient, but one who also had these two copies of the genetic mutation to see if they would get the bonus of treating the HIV, while treating the more urgent need - cancer.

Here’s where the German doctors admit they were very lucky. They told reporters they normally find one to five qualified donors for their patients in need of a transplant. In this case they found 80 donors. So they systematically tested each donor for the mutation and when they came to the 61st potential donor they hit the jackpot. Nearly two years after the bone marrow transplant, the patient is still in remission from his cancer and he doesn’t seem to have any detectable HIV either.

This is probably why many newspaper headlines interpreted the success as being a cure.

However there are many caveats to this story.

1. Even though their tests do not show a presence of HIV in his system, doesn’t mean it’s not there. This virus is known for hiding well and popping up later. It’s been seen before in patients taking anti-retroviral drugs. It is possible that if more sophisticated tests were used on this patient, they would detect the virus that is still in his body. So it’s still not entirely clear that he is HIV-free.

2. 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.

3. Bone marrow transplants are dangerous for patients. Before they can get the donated stem cells that will replace their own, they have to take strong chemotherapy to destroy their own bone marrow — leaving them without an immune system to fight off any disease — until the transplanted bone marrow can make new blood cells. Plus patients run the risk of rejecting the new cells, which means they have to take immune-suppressing drugs for the rest of their life.

4. Bone marrow transplants are very expensive and not an option for many people living with this disease around the world.

Both the doctors in Berlin and AIDS experts we’ve spoken with say this is a “proof of principle.” “It’s an interesting case for researchers,” according to Dr. Rudolf Tauber, from the Charite hospital in Berlin, where the patient was treated. The hope is that this one case could lead to future treatments. Dr. Gallo says, “If patients living with HIV and AIDS have access and can adhere to today’s retroviral therapy, many will live longer, healthier lives, perhaps full length lives.”

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

I have logged hundreds of thousands of miles, looking at the burden of AIDS around the world. I have been with the Partners in Health teams in Rwanda and the Clinton Foundation in Kenya. I have seen the work being done in Haiti, to name a few. Today, I would like to draw some comparison with what is happening right here at home.

Yesterday the Black AIDS Institute reported that if African-Americans with HIV/AIDS were their own country, they would make up more HIV/AIDS cases than seven of the countries currently receiving emergency funding for… AIDS. Think about that. There are almost 600,000 African-Americans living with HIV, and there are still 30,000 newly infected cases every year. As things stand now, AIDS remains the leading cause of death among African-American women between the ages of 25 and 34, and the second-leading cause of death among African-American men between 35 and 44 years of age.

As Jesse Milan, board chair of the institute, said, “When the world wasn’t looking, the AIDS epidemic refused to go away.”  AIDS has always been a disparate African-American problem. Even at the beginning of this epidemic in the United States, when there were only a few thousand cases, more than a quarter of them were among African-Americans.

Today, 47% of the HIV cases in the United States are in African Americans, even though African Americans make up only 13% of the population. If you peer deeper into certain cities, you find of all the HIV cases in Washington DC, 80 percent are among African Americans. In Jackson, Mississippi – 84%.

Add to all of this: In New York City, African Americans living with HIV are 2 and half times more likely to die as compared to HIV infected Caucasians. So, African Americans living in the United States are more likely to have HIV and more likely to die from it. Staggering.

And, here is another thing — AIDS rates in this nation’s Latino community are increasing with little notice. Though Hispanics make up about 14 percent of the U.S. population, they represented 22 percent of new HIV and AIDS diagnoses tallied by federal officials in 2006.

No doubt, if you live in a resource rich country like Denmark or the United States, you have a better chance at living a longer life with HIV as compared to many other places around the world. But still, the stats you are reading this morning are worse in some ways than a few of the Sub Saharan countries we typically associate with the worst of the AIDS burden.

So, what to do? I think most would agree that global funding for AIDS needs to be a continued priority. Today the President will authorize 48 billion more dollars toward those efforts. But, how do you think we should better address the AIDS/HIV problems at home?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Miriam Falco
CNN Medical Managing Editor

You may have heard the news yesterday, that New York City wants everyone in the Bronx tested for HIV (read story).
Sounds like an ambitious project. The New York City Health Department says they are launching their largest ever HIV testing program today. They want every resident of the Bronx — ages 18 to 64 — to know if they do or do not have HIV. They hope that over the next three years, the 250,000 adults living in the Bronx who’ve never been tested will know if they’ve been infected with the virus that causes AIDS.

But this is not a local New York effort. It’s part of a nationwide campaign. Today is “National HIV Testing Day.” The Centers for Disease Control and Prevention (CDC) estimates nearly 40 percent of those infected with HIV don’t find out until they’re already sick with AIDS. The CDC also reports that more than a million people were living with HIV/AIDS in the United States in 2003. What’s really striking is that they say about 1 in 4 of those didn’t know they were infected.

Knowing you’ve been infected with HIV as early as possible is key to living longer. Here’s how the CDC’s Director of the National Center for HIV/AIDS put it: “If you are infected, you can take steps to protect your health and that of your partners as well as seek life-extending medical treatment. People who learn they are not infected can take steps to help ensure they remain uninfected.”

Preventing HIV transmission, by avoiding risky behavior (i.e. having unprotected sex or sharing needles), is of course the primary goal of public health officials. But on this 16th “National HIV Testing Day” it’s clear that knowing your HIV status is critical too.

If you are wondering where you can get an HIV test, you can find a testing site by clicking on www.hivtest.org. I did and found there are 23 sites within a ten mile radius of CNN.

Advocates would like to see HIV testing as part of everyone’s routine health check-up. Have you been recently tested for HIV? Do you think it should be part of your regular medical check-up?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Miriam Falco
CNN Medical Managing Editor

You may not know it, but the first-ever high level meeting on HIV/AIDS and tuberculosis is underway at the United Nations right now. The former president of Portugal and UN Secretary General’s Special Envoy to Stop TB, Dr. Jorge Sampaio, told reporters yesterday that the “meeting was convened to draw the attention of the world to a much neglected topic” - how TB is affecting HIV/AIDS patients and vice versa.

People living with HIV/AIDS cannot be cured, but they can live longer, with the help of antiretroviral drugs. Thanks to generous donations from the Global Fund,  UNAIDS, the Bill and Melinda Gates Foundation and the U.S. PEPFAR plan - the President’s Emergency Plan for AIDS Relief, even people in the poorest countries are gaining access to these life-saving drugs.

The Global Fund even documented some intriguing stories of people being pulled from the brink of death by taking anti-retroviral drugs in a collection of photographs taken by some of the world’s best photographers. These pictures and stories go on display at the Mellon Library in Washington DC tomorrow, June 11th.  You can see a special preview here.

However, too many HIV/AIDS patients aren’t living long enough to reap the benefits of antiretrovirals because they’ve dying of TB first. The World Health Organization says an estimated one third of people living with HIV or AIDS also are infected with TB. If you’re one of those people, you’re up to 50 times more likely to develop TB than non-HIV infected people and the WHO says TB kills up to half of all AIDS patients worldwide.

The statistics for TB around the world are quite startling. According to the latest figures from the CDC, approxiamately 2 billion people, or one third of the worlds population carry the bacteria that causes tuberculosis — that doesn’t mean they have active TB, but they could develop it.

The WHO says “HIV is the most potent risk factor for converting latent TB into active TB, while TB bacteria accelerates the progress of AIDS infection in the patient.” Dr. Jim Reichman from the New Jersey Medical School Global Tuberculosis Institute puts it another way: “TB accelerates AIDS and AIDS accelerates TB.”

The CDC also says 16 percent of TB cases among 25-44 year-olds in the United States in 2005 were occuring in HIV infected people.

So you may not have HIV or AIDS or TB for that matter and may not live in a poor country with fewer resources to control these diseases. But, as we all learned a year ago in the Andrew Speaker case, we may be just a vacation away or a a plane trip away from coming in contact with someone carrying TB. Speaker, you may recall, is the Atlanta lawyer who contracted TB while traveling in Asia and later flew to and from Europe, knowing he had multi-drug resistant tuberculosis.

“TB is preventable and curable and it’s been so for decades” says Dr. Reichmann. This is why health officials are trying to convince the global leaders gathering at the U.N. today, to encourage countries around the world to invest more in TB prevention and treatment. To paraphrase many TB & AIDS experts, to control TB anywhere, you have to control it everywhere. But so far there’s no big celebrity sponsored campaign to raise a lot of money for eradicating TB. That’s why Dr. Marcos Espinal, Executive Secretary of the Stop TB Partnership told reporters yesterday, “what’s highly needed is a global plan for TB and that countries embrace the plan” in order to stop the spread of HIV and TB.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

Dr. Sanjay Gupta, on assignment in Lima, Peru had the chance to stop by an AIDS prevention clinic.  Watch a behind-the-scenes look at what he found, and the tactics Peruvian doctors are using to prevent the transmission of HIV/AIDS from mothers to their newborns.

Do you think these efforts will have a major impact on the spread of this tragic disease?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.