HIV/AIDS patients “cured” by bone marrow transplants

On the heel of the news that the HIV/AIDS virus is being used a possible cure for cancer, we now have a cure for cancer possible curing HIV/AIDS.

Researchers presented two cases of presumed HIV “cure” at the International AIDS Society in Kuala Lumpur, Malaysia.

Both of these men, who had longstanding HIV, and had undergone bone marrow transplant for treatment of lymphoma that had relapsed after chemotherapy.  The patients received immunosuppressants and somewhat mismatched bone marrow.  They remained on combined antiretroviral therapy after the transplants.

The researchers hoped that the lymphoma cells would be killed and that the donor marrow cells would engraft in the patients, giving them healthy bone marrow.  The researchers didn’t expect that all traces of HIV would be removed, as well.  Yet, in these two patients, after receiving the donor marrows and being maintained on antiretroviral therapy (ART), all evidence of HIV in both plasma and peripheral blood mononuclear cells, vanished.

After some time, the researchers decided to stop the antiretrovirals to see if the HIV became detectable again.  Both patients have remained free of any laboratory evidence that any HIV remains.  They still have no detectable traces of HIV in either plasma or mononuclear cells even after the antiretrovirals were stopped.

The researchers are not calling this a cure as yet. They want to do biopsies and see if all traces of any possible HIV is left in any “reservoir” tissues (HIV can infect, and then lie dormant in, T cells, other mononuclear cells and some other cell types).  Right now, they are leaning toward using the phrase “in remission.”

HIV/AIDS ribbon via Shutterstock

HIV/AIDS ribbon via Shutterstock

The “Berlin Patient” similarly became HIV negative (“cured”) after a bone marrow transplant.  However, in his case, the donor marrow was carefully selected so that it came from a donor with the delta32 mutation.  This mutation makes the donor cells impervious to infection with HIV.  The marrows in these two cases did NOT come from delta32 donors.  The conclusion reached by the research team is that the antiretroviral drugs totally repressed the patients’ HIV while the healthy cells took over and now there is no HIV left to infect the new, healthy cells.

Obviously, this is not a safe, cheap or easy “cure.”  Bone marrow transplant carries about a 15-20% risk of causing death.  In the initial study, three patients were enrolled.  One died after engraftment of the bone marrow from complications of the procedure. The procedure is expensive, treatment has multiple side effects, and there are other drawbacks, as well.

However, this research suggests that ART may totally prevent HIV replication in infected patients.  If this is the case, there may be a method found in the near future that will allow the HIV reservoirs in the infected patients to be neutralized thereby leading to a permanent cure for those infected with HIV.

This research is complementary to that done on the HIV+ newborn who was given antiretrovirals immediately after birth, before hidden reservoirs of HIV could form, and is also presumably cured of her HIV infection.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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