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Bone marrow transplant may have cured AIDS in one patient
Virus has not been detected for more than 600 days in transplant recipient.
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A patient with leukemia and HIV recently received bone marrow from a donor who had inherited the CCR5 deletion. The patient is still recovering from the leukemia therapy, but AIDS has not been detected in his system for almost two years.
The patient was a 42-year-old American man living in Berlin, Germany. The attending physician was hematologist Gero Hutter, MD. Hutter is not an HIV/AIDS specialist but he deliberately sought a bone marrow donor with the CCR5 mutation.
Prior to the transplant, Hutter and colleagues destroyed bone marrow and immune system cells in the patient. They also ordered him to cease taking AIDS medications. They expected HIV to re-emerge in the blood during the patient’s recovery, but it has not yet been detected.
Most researchers and clinicians in the field believe that functionally, curing AIDS through this method is possible. Paul Volberding, MD, professor and vice chair of the department of medicine at the University of California, San Francisco, and Infectious Disease News editorial advisory board member, was not involved in the procedure but discussed the results in an interview. “Given what we know about the CCR5 deletion, this result is not incredibly surprising,” he said.
The CCR5 deletion is passed on through both parents in about 1% of Europeans. The mutation is almost non-existent in African, Asian and South American populations. “I think many people in the field see this result as an interesting observation,” Volberding said. “However, we do not want to get overly enthusiastic.”
It is widely accepted that the procedure is too risky to be used or even tested on a broad scale. The mortality rate for a bone marrow transplant is about 30%.
“We are not going to see people with HIV racing out to get bone marrow transplants,” Volberding said. “It is an incredibly aggressive and risky procedure for an infection that, at this point, can be pretty effectively treated with oral therapy. There are grave dangers to making someone with HIV immunosuppressed to this extent. I would not expect even to see prospective clinical trials of this.”
Gene therapy
Though the result likely will not lead to a radical change in approach to HIV treatment, it has re-invigorated the discussion of gene therapy as a potential avenue to be explored. The field of gene therapy as HIV treatment has seen some setbacks, and continued challenges lay ahead. However, some see the turn of events in Germany as a reason for hope.
“What people are asking is whether there is genetic therapy that could accomplish what the transplant accomplished without the risk of bone marrow transplant,” Volberding said. “However, I am not sure how that could be accomplished, because genetic therapy generally involves some degree of conditioning that is similar to transplant itself.”
Volberding also had some general comments about the case. “I think it is an important case report,” he said. “But we have seen a lot of remarkable case reports that turn out not to take us very far in the field. I do not think this changes the field materially.” – by Rob Volansky