"....not a course of treatment for the faint-hearted."

December 14, 2010 7:23 AM

Stem cell transplant has cured HIV infection in 'Berlin patient', say doctors. Doctors who carried out a stem cell transplant on an HIV-infected man with leukaemia in 2007 say they now believe the man to have been cured of HIV infection as a result of the treatment, which introduced stem cells which happened to be resistant to HIV infection.
posted by Fizz (34 comments total)

The course of total irradiation chemotherapy, immunosuppressive drug therapy, and stem cell transfer that the patient had to receive to achieve this result sound grueling and would give anyone considerable pause. He went temporarily blind, had two leukemia relapses, underwent a major neurological disorder, and is still having problems with coordination and gait.

Still, this is amazing news, especially if it points the way toward treatments that aren't as slash-and-burn.
posted by blucevalo at 7:36 AM on December 14, 2010 [3 favorites]

It's a pretty rough way to go about a cure. Still, it sounds encouraging for future therapies.
posted by Blazecock Pileon at 7:38 AM on December 14, 2010 [1 favorite]

That's a lot of work to go to, just to thwart God's will.
posted by Wolfdog at 7:39 AM on December 14, 2010 [11 favorites]

Wolfdog: surely you have forgotten your "/hamburger" ?
posted by SLC Mom at 7:40 AM on December 14, 2010 [2 favorites]

What WON'T stem cells do? I'm going to drink a stem cell shake right now just for the hell of it.
posted by glaucon at 7:42 AM on December 14, 2010 [6 favorites]

They will NOT get you high. Whooo boy I won't try that a second time and not just because I'm banned from the bio department buildings
posted by Salvor Hardin at 7:44 AM on December 14, 2010 [12 favorites]

This is an intriguing case.

The question to the patient,
"On being asked if it would have been better to live with HIV than to have beaten it in this way ...”, denotes a misunderstanding of the primary intent of the transplant. The patient would not have been able to "live with HIV." He would have died of the leukemia.

It is also remarkable that the donor coordinators were able to find a donor both HLA (stem cell) matched and resistant to HIV. It suggests that the patient has a fairly common HLA type. Most people are not so fortunate.
posted by SLC Mom at 7:50 AM on December 14, 2010

In other transplant news: poo transplants to fight C. difficile.
posted by caddis at 7:55 AM on December 14, 2010

*draws a brief vertical line on a very long wall*

One.
posted by adipocere at 7:59 AM on December 14, 2010 [12 favorites]

It's hard to imagine a medical headline more perfectly calculated to make the religious right start frothing at the mouth.
posted by pts at 8:00 AM on December 14, 2010 [7 favorites]

It's hard to imagine a medical headline more perfectly calculated to make the religious right start frothing at the mouth.

"Stem cells harvested from dead Ronald Reagan used to help cure left-leaning liberal nazi homosexual aids patient! Operation to be performed on the steps of the Washington Monument."
posted by Fizz at 8:07 AM on December 14, 2010 [33 favorites]

pts: If you're thinking there's a pro-life angle to this, there isn't - the stem cells were adult stem cells. Not fetuses required. Although I heard they killed some anyways, for science.
posted by Salvor Hardin at 8:08 AM on December 14, 2010 [3 favorites]

It suggests that the patient has a fairly common HLA type. Most people are not so fortunate.

Huh? :)
posted by Debaser626 at 8:11 AM on December 14, 2010 [2 favorites]

"It's hard to imagine a medical headline more perfectly calculated to make the religious right start frothing at the mouth."

How so? The religious right isn't opposed to stem cell research -- in fact, they promote the kind of research described in the story as an alternative to embryonic stem cell research.

Unless you're talking about the fringe whackos who might simply be opposed to curing AIDS in general.
posted by BurntHombre at 8:14 AM on December 14, 2010

It suggests that the patient has a fairly common HLA type. Most people are not so fortunate.

Huh? :)

No idea, but it's worth mentioning that it's notoriously difficult to find compatible marrow donor/recipient pairs. It's not remotely as simple as a blood transfusion, and a lot of leukemia patients are unable to be treated this way, because no compatible donor could be found.

Shameless plug: If you're eligible, you should enter yourself into the Marrow Donor Registry to help improve the odds.
posted by schmod at 8:19 AM on December 14, 2010

Stem cells harvested from dead Ronald Reagan used to help cure left-leaning liberal nazi homosexual aids patient! Operation to be performed on the steps of the Washington Monument...

thanks to medicare.
posted by Mr. Anthropomorphism at 8:19 AM on December 14, 2010 [8 favorites]

Stem cells harvested from dead Ronald Reagan used to help cure left-leaning liberal nazi homosexual aids patient! Operation to be performed on the steps of the Washington Monument...


That'd be about the only good deed attributable to Reagan...
posted by stenseng at 8:26 AM on December 14, 2010 [1 favorite]

This is good news. However, it's not news that's likely to turn the tide of an epidemic that's estimated at 33 million people world wide, and among ethnic groups that are notoriously undeserved by blood marrow donors.
posted by KirkJobSluder at 8:30 AM on December 14, 2010

N.B. The Berlin Patient had HIV, not AIDS.
posted by schmod at 8:56 AM on December 14, 2010

"It's hard to imagine a medical headline more perfectly calculated to make the religious right start frothing at the mouth."

This amazing, life saving medical breakthrough is reported and rather than celebrate you want to turn it into an excuse to randomly mock people? That's petty even by internet standards.
posted by mikoroshi at 9:14 AM on December 14, 2010

Unless you're talking about the fringe whackos who might simply be opposed to curing AIDS in general.

A larger "fringe" than one might expect.
posted by blucevalo at 9:14 AM on December 14, 2010 [2 favorites]

Stem cells harvested from dead Ronald Reagan used to help cure left-leaning liberal nazi homosexual aids patient! Operation to be performed on the steps of the Washington Monument...

...by a doctor who NEVER says "Merry Christmas."
posted by PlusDistance at 9:16 AM on December 14, 2010 [7 favorites]

The religious right isn't opposed to stem cell research -- in fact, they promote the kind of research described in the story as an alternative to embryonic stem cell research.

The people opposed to this research are not known for making fine distinctions (among things that actually exist, I mean).
posted by DU at 9:17 AM on December 14, 2010 [3 favorites]

Unless you're talking about the fringe whackos who might simply be opposed to curing AIDS in general.

Are these the same fringe whackos who were up in arms about vaccinating girls against HPV, e.g. the Texas Senate?
posted by 0xFCAF at 10:28 AM on December 14, 2010

"Are these the same fringe whackos who were up in arms about vaccinating girls against HPV, e.g. the Texas Senate?"

Unknown, but I'm pretty sure they're not.
posted by BurntHombre at 10:32 AM on December 14, 2010

It suggests that the patient has a fairly common HLA type. Most people are not so fortunate.

Huh? :)

Most people belong to rare HLA groups, like unhappy families, they're all different.
posted by atrazine at 11:00 AM on December 14, 2010

So, he had HIV, and now he doesn't have HIV?

That is a fucking miracle! I was born in '83, I don't remember a world without AIDS in it, and honestly with so much money to be made in lifetime long treatment plans, I never expected a proper cure to be developed.

This is amazing. I finished my Christmas shopping last night, but if none of it was done this morning, I think I would give the whole budget to helping fund the cure for HIV.

Wow.
posted by paisley henosis at 11:27 AM on December 14, 2010 [1 favorite]

It suggests that the patient has a fairly common HLA type. Most people are not so fortunate.

Huh? :)

No, that makes sense. Suppose there are 6,000,000,1000 people on the planet, and 3 billion types of HLA. For every type of HLA, there are only two people on the planet who have it. Except for the most common type of HLA, which 1001 people have.
posted by foursentences at 12:08 PM on December 14, 2010 [1 favorite]

Stem cells harvested from dead Ronald Reagan used to help cure left-leaning liberal nazi homosexual aids patient! Operation to be performed on the steps of the Washington Monument...

Psst. Fizz. How about we do it on the steps of the Lincoln Memorial? The Washington Monument doesn't have steps, at least not outside.
posted by jocelmeow at 12:31 PM on December 14, 2010 [2 favorites]

"They have now published a follow-up report in the journal Blood"
Med journals have simple, direct titles that are so awesome sounding.

Seriously this is wonderful exciting news. Many of the major cancer centers are expanding hematology areas to met the current demand. MD Anderson is performing over 600 SCTs a year now.

It is amazing and encouraging what he survived to this point. I'm rather overjoyed to read this!
posted by dog food sugar at 12:43 PM on December 14, 2010

It suggests that the patient has a fairly common HLA type. Most people are not so fortunate.

Huh? :)

No idea, but it's worth mentioning that it's notoriously difficult to find compatible marrow donor/recipient pairs. It's not remotely as simple as a blood transfusion, and a lot of leukemia patients are unable to be treated this way, because no compatible donor could be found.

Yep. That's it. Schmod has it. It can be hard to find compatible stem cell donors. Gratuitious link to some HLA information So can you imagine finding a donor who is both perfectly matched AND HIV resistant? This is not going t be a common therapy, but hopefully it will lead to bigger and better things.
posted by SLC Mom at 2:22 PM on December 14, 2010

As much as I want to start going apeshit with joy and wonder about this, the pessimist in me want to go apeshit with other explanations. For instance, his treatment for leukemia (a cancer of the white blood cells) basically involved the complete and total tear down of his immune system, the very system that HIV infects. His immune system was then built back up through massive stem cell transplants. As the article notes there is the possibility of HIV surviving in the longer lived cells that were not destroyed during the leukemia therapy, although, 3 years out this seems unlikely.

The article doesn't mention specifically which HIV tests they're using, but, from what is written, it looks like all of them. The only really important ones in this case are the antibody tests (viral load testing being somewhat moot in this situation). While antibody test, particularly modern HIV antibody tests, are super duper good at catching the slightest whiff of HIV infection (wikipedia cites 99.7% sensitivity, 98.5% specificity), they can still miss incredibly low levels of infection. If this guy (who I hesitantly want to call "Lucky") does have minute levels of HIV still hanging out buried in his system then it's possible he could still re-develop AIDS in the future.

So, worst case scenario, this Lucky's HIV infection has been knocked down to sub-square one levels. Best case scenario, we cured AIDS, even if the cure is the equivalent of having your immune system scraped out, sandblasted down, and then replaced with someone else's cells.
posted by Panjandrum at 5:57 PM on December 14, 2010 [2 favorites]

Maybe in the future doctors could create custom bone marrow from your own stem cells that have been genetically modified to carry the "immune to HIV" gene. Right now, you need to find a donor who is 1) an exact match and 2) carries that gene.
posted by delmoi at 11:50 PM on December 14, 2010

I think the question that SLC Mom objected to is trying to ask about this. I read it as, "Suppose you didn't have leukemia. Would you have gone through this treatment to cure your HIV?" Which is actually a damn good question. The treatment was brutal - chemo, 38 months of immunosuppressive drugs, colon biopsies, temporary blindness, lasting neurological changes. This is a long way from being a "cure" (in the general sense) but still an exciting development.
posted by zanni at 1:03 AM on December 15, 2010 [1 favorite]