Perhaps you’ve seen the story of the 44-year-old American man reportedly “cured” of HIV in Germany–it’s been making the rounds over the past week. What’s actually happening here?
This is a story that dates back a few years; in fact, 80beats blogged about this case years ago when it first made the news. Back in 2007, the man—Timothy Ray Brown—was an HIV-positive patient suffering from acute myeloid leukemia. When standard chemotherapy couldn’t help him, his docs in Germany turned to a bone marrow transplant, with one twist.
Brown’s oncologist decided to look for a bone marrow donor who had a had a special genetic mutation that made the stem cells in it naturally resistant to HIV infection. His physician, Dr. Gero Huetter, was able to find this rare match and Brown got the bone marrow transplant. He needed a second stem cell transplant because the cancer came back. Today, he appears to be cancer free and doctors can’t find traces of the virus that causes AIDS either. [CNN]
Brown’s treatment made a splash in the news in 2008, when the doctors first reported on it. It has resurfaced this month because the researchers published a new study in the journal Blood updating his condition.
The researchers confirmed that Brown seems to have maintained his resistance to HIV for three years, confounding their expectation that he would become reinfected. They concluded that a “cure of HIV has been achieved in this patient.” [New Scientist]
Because the scientists used the magic word “cure,” the story zoomed across the Web this week. But doctors commenting on the research are careful to point out that a treatment that was seemingly effective in one man does not equal a cure for the 33 million people living with HIV worldwide.
For one thing, this is an individualized procedure: Brown had to be matched carefully with the donated marrow so his body would not reject it, and that was difficult to achieve. In addition, only about 1 percent of Caucasians have the HIV-resistant variant in their bone marrow, CNN reports—”zero percent of African Americans or Asians have this particular genetic mutation.”
And then there’s the question of killing the patient to cure the disease.
“This probably is a cure, but it comes at a bit of a price,” said Dr. Michael Saag, professor of medicine and director of the University of Alabama at Birmingham AIDS Center. “For him to receive the donor cells, his body had to have all of his immune system wiped out” and then receive a bone marrow transplant, Saag noted. “The Catch-22 here is that the best candidates for a cure, ideally, are people who are healthy” and don’t have leukemia. The treatment associated with wiping out the immune system “is very hazardous,” he said in a telephone interview. [CNN]
Not everyone would make it through the procedure, according to Margaret Fischl of the AIDS clinical research unit at the University of Miami.
This treatment also carries with it a 30 percent risk of death, Fischl added. “That he was young and got through it is quite remarkable,” she said. “I would never give this to a healthy patient. I could never justify it. If you use this therapy, 30 percent of your patients could die from the intervention.” [U.S. News & World Report]
The study is an open door to new research avenues, Fischl says, not a treatment to be used immediately.
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Image: Wikimedia / HIV Budding