November 13, 2008—German hematologists announced yesterday
that a bone marrow transplant appears to have cured a leukemia
patient of HIV/AIDS.
The news was delivered at a press conference—not as a published
report in a peer-reviewed scientific journal—and HIV experts are
skeptical that the German team's failure to detect HIV in the patient
means all of the virus has actually been eradicated from his body.
"A lot more scrutiny from a lot of different biological samples would be
required" to say HIV's truly absent, cautioned Andrew Badley of the
Mayo Clinic in Rochester, MN.
If confirmed and replicated, however, the case could mark an import-
ant advance in the search for HIV/AIDS treatments.
Nearly 2 years ago Dr. Gero Huetter of Berlin's Charite Hospital faced
the unusual task of planning treatment for a patient who had both
leukemia and HIV/AIDS. So when he scheduled a bone marrow
transplant to treat the 42-year old American man's leukemia, he
sought out a marrow donor with innate, genetic resistance to HIV
infection.
Roughly 1 in 1000 Europeans carry two copies of a genetic mutation
known as Delta-32, rendering them resistant to HIV. The presence of
Delta-32 mutations may be evidence of an ancient HIV epidemic
among ancestral Europeans. Huetter suspected that a donor with
these mutations may be able to give his patient not only cancer-free
bone marrow, but HIV resistance as well.
After intensive radiation therapy to kill the patient’s own bone marrow
and highly active anti-retroviral therapy (HAART) to diminish his body’s
HIV viral load, he received bone marrow from the HIV-resistant donor.
Twenty months later, Huetter's team reports that they have been
unable to detect any evidence of HIV in the patient's body.
In 1999, I. Huzicka of Charles University in Prague, Czech Republic,
reviewed 32 attempts around the world to cure AIDS with bone marrow
transplants. The first attempt was in 1982.
In 2 of those 32 patients, HIV could not be detected after bone marrow
transplant. Another patient experienced a transient but sharp drop in
HIV levels.
Bone marrow transplant is an anti-HIV strategy that seems to makes
sense. Bone marrow is an extracellular refuge and reservoir for HIV.
And marrow transplants remove infected and susceptible cells from the
patient’s body.
But as recently as last year French researchers reported that
combining bone marrow transplant and HAART failed to cure
HIV/AIDS.
The German team’s possible success may have resulted from the
choice of an HIV-resistant bone marrow donor or intensive pre-
transplant radiation therapy—or both. The doctors were quick to
caution that it may also have been a fluke.
It is unclear how many HIV/AIDS patients could benefit from this
dangerous procedure. Up to 30 percent of patients may die as a result
of the procedure itself, experts say.
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A cure for AIDS?
The case was announced at a press conference, not in
a peer-reviewed medical journal...and it may be a fluke.
But if confirmed and replicated, it could lead to new
treatment options for AIDS patients.
It is unclear how many AIDS patients may benefit from
Huetter's approach. The procedure is very dangerous and
may kill up to 30 percent of patients. But the case may
point the way to new genetic and cloning-based therapies.