Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant

[Guest guest]

[Editors note: Abstract of the article follows the news item]:

Evidence for the cure of HIV infection by CCR5 32/ 32 stem cell transplantation

a Allers1,*, Gero Hütter2, Jörg Hofmann3, Christoph Loddenkemper4,

Kathrin Rieger2, Eckhard Thiel2 and Schneider1

_________________________

Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant

Published December 14, 2010/FoxNews.com

There's an estimated 33 million people worldwide living with HIV/AIDS, and now

doctors believe one of them may have been cured of the virus after receiving a

stem cell transplant in 2007, the medical journal Blood reported.

Ray Brown, an HIV-positive American living in Germany, had leukemia and

was undergoing chemotherapy, when he received a transplant of stem cells from a

donor carrying a rare, inherited gene mutation that seems to make carriers

virtually immune to HIV infection.

The transplant appeared to wipe out both diseases, giving hope to doctors, but

Dr. Fauci, director of the National Institutes of Allergy and Infectious

Diseases, who has been studying HIV/AIDS for almost 30 years, said while this is

an interesting proof of concept, it's absurdly impractical.

" It's hard enough to get a good compatible match for a transplant like this, "

Fauci told FoxNews.com, " But you also have to find compatible donor that has

this genetic defect, and this defect is only found in 1 percent of the Caucasian

population and zero percent of the black population. This is very rare. "

Fauci said while this patient is " functionally cured " this is not something you

can do with every HIV-infected individual.

" This is not prime time to me at all, " he said. " This is a very unusual

situation that has little practical application for a simple reason. This donor

not only had to be a good compatible match, but the donor had to have a genetic

defect of cells that do not express the receptor that the HIV virus needs to

enter the cell. "

Fauci also pointed to the fact that this transplant process is not only

expensive, it's incredibly painful and complicated, and requires the patient to

start a whole new regimen of drugs.

" This patient is trading one poison for another. He may not have to

be on antiretroviral drugs anymore, but he has to take immunosuppressant drugs

now to prevent the rejection of his transplant cells. Again, what this is, is an

interesting proof of concept, but it's absolutely impractical. "

Dr. Quinn, director of s Hopkins Center for Global Health told

FoxNews.com that he is very familiar with the " Berlin patient " case.

" This was a new report that looked much deeper into whether HIV could still be

present or lurking in the body in some way, not cured, and since the transplant

he remains viral free and his cells appear to be resistant to infection, " he

said.

Quinn said he agrees with the researchers on this case that it would be

qualified as the first HIV cure, opening the door to alternative means of curing

HIV.

" He [brown] has been without therapy for three years and appears to be free of

the virus, " he said. " It gives hope to the millions of people infected with HIV

that cure is a feasible option in the future. "

Even though Brown's procedure proved to be successful, Quinn also warns that

this was a rare case and a bone marrow transplant is not a cure-all for other

HIV patients.

" It is a near fatal procedure that he had to have done because of the leukemia,

but this procedure is very expensive and you have to be transplanted with a

donor who is shown to be already resistant to HIV, " Quinn said. " You're asking

for a tall order to replicate this in the future. "

Brown's case was published in a February 2009 issue of the New England Journal

of Medicine.

http://www.foxnews.com/health/2010/12/14/doctors-claim-hiv-positive-man-cured-st\

em-cell-transplant/

________________

Evidence for the cure of HIV infection by CCR5 32/ 32 stem cell transplantation

a Allers1,*, Gero Hütter2, Jörg Hofmann3, Christoph Loddenkemper4,

Kathrin Rieger2, Eckhard Thiel2 and Schneider1

1 Department of Gastroenterology, Infectious Diseases, and Rheumatology, Medical

Clinic I, Campus lin, Charite - University Medicine Berlin,

Germany; 2 Department of Hematology, Oncology, and Transfusion Medicine, Medical

Clinic III, Campus lin, Charite - University Medicine Berlin,

Germany; 3 Institute of Medical Virology, Helmut-Ruska-Haus, Campus Mitte,

Charite - University Medicine Berlin, Germany; 4 Institute of Pathology/Research

Center ImmunoSciences (RCIS), Campus lin, Charite - University

Medicine Berlin, Germany

* Corresponding author; email: kristina.allers@...

Blood First Edition Paper, prepublished online December 8, 2010; DOI

10.1182/blood-2010-09-309591.

Abstract

HIV entry into CD4+ cells requires interaction with a cellular receptor,

generally either CCR5 or CXCR4. We have previously reported the case of an

HIV-infected patient in whom viral replication remained absent despite

discontinuation of antiretroviral therapy after transplantation with CCR5 32/ 32

stem cells.

However, it was expected that the long-lived viral reservoir would lead to HIV

rebound and disease progression during the process of immune reconstitution. In

the present study, we demonstrate successful reconstitution of CD4+ T cells at

the systemic level as well as in the gut mucosal immune system following CCR5

32/ 32 stem cell transplantation, while the patient remains without any sign of

HIV infection.

This was observed although recovered CD4+ T cells contain a high proportion of

activated memory CD4+ T cells, i.e. the preferential targets of HIV, and are

susceptible to productive infection with CXCR4-tropic HIV. Furthermore, during

the process of immune reconstitution, we found evidence for the replacement of

long-lived host tissue cells with donor-derived cells indicating that the size

of the viral reservoir has been reduced over time.

In conclusion, our results strongly suggest that cure of HIV has been achieved

in this patient.

[Guest guest]

Dear Forum Members,

/message/12359

This is in continuation with the letter posted as 'Doctors Claim HIV-Positive

Man Cured by Stem Cell Transplant'

Yes, CURE for AIDS is very much possible but not a very easy procedure,

expensive and not possible for all.

First it appeared in 2009 itself in the New England journal of medicine as

Long-Term Control of HIV by CCR5 Delta32/Delta32 Stem-Cell Transplantation, N

Engl J Med 2009; 360:692-698February 12, 2009.

Abstract: Infection with the human immunodeficiency virus type 1 (HIV-1)

requires the presence of a CD4 receptor and a chemokine receptor, principally

chemokine receptor 5 (CCR5). Homozygosity for a 32-bp deletion in the CCR5

allele provides resistance against HIV-1 acquisition. We transplanted stem cells

from a donor who was homozygous for CCR5 delta32 in a patient with acute myeloid

leukemia and HIV-1 infection. The patient remained without viral rebound 20

months after transplantation and discontinuation of antiretroviral therapy. This

outcome demonstrates the critical roleCCR5 plays in maintaining HIV-1 infection.

Yes. Now this patient is declared to be cured from AIDS as he is completely free

from HIV for more than three years.

About one in 100 Caucasian people, or one per cent of the population, have the

mutation, known as Delta 32, inherited from both parents which prevents the

protein CCR5 from appearing on the cell surface.

Since HIV enters the cell through CCR5 molecules, when they are absent HIV

cannot penetrate.The process was not easy, but after rejecting dozens of

potential donors Hutter finally found a match and performed the bone marrow

transplant using stem cells from the HIV-resistant donor in February 2007.

So we need a stem cell from such donor which is very rare to obtain.

Then as pointed out in this letter posted in AIDS INDIA forum that " This patient

is trading one poison for another. He may not have to be on antiretroviral drugs

anymore, but he has to take immunosuppressant drugs now to prevent the rejection

of his transplant cells.

Again, what this is, is an interesting proof of concept, but it's absolutely

impractical. "

Presently the reason for which we are not able to achieve a complete cure with

the help of ART in spite our achievement of undetectable viral load is said to

be the presence of dormant virus or HIV latency.

Now they identified an enzyme called as Histone Deacetylase which is responsible

to keep up latency. Several companies are looking into H-Inhibitors. Some in

vitro H-DAC studies seemed to be promising but yet to be confirmed by clinical

studies.

By keeping all these in mind we shall expect a still simple procedure which is

amicable for reach of all common man.

It may come in row in another few years. we will hope for the best.

Dr S.Murugan

Senior consultant in HIV medicine,

Shifa Hospitals, CCC Medical officer,

Tirunelveli- Tamilnadu

e-mail: <muruganyes@...>