Two men who had hoped they might be cured of an HIV infection after getting bone marrow transplants for cancer got some bad news, doctors said Monday. The virus has come back.
The intense and life-threatening treatments for cancer appeared to have wiped the virus out, and the two men took a chance and, earlier this year, stopped taking the HIV drugs that were keeping the virus under control.
At first, no signs of the virus could be found. But their doctors, cautious after decades of fighting a tricky virus, didn’t declare a cure.
“It’s disappointing,’ said Dr. Daniel Kuritzkes of Brigham and Women’s Hospital in Boston, who worked with Dr. Timothy Henrich to treat and study the two men.
“But it’s still taught us a great deal.”
The case of the two men shows that even if you make HIV seemingly disappear, it can be hiding out in the body and can re-activate. It might be somewhere other than in blood cells, Henrich said. Other scientists suspect HIV might be able to hole up in organs or inside the intestines.
“Through this research we have discovered the HIV reservoir is deeper and more persistent than previously known and that our current standards of probing for HIV may not be sufficient to inform us if long-term HIV remission is possible if antiretroviral therapy is stopped,” Henrich said.
“Both patients have resumed therapy and are currently doing well.” Neither man wants to be named.
Henrich, Kuritzkes and colleagues had actively looked for HIV patients with leukemia or lymphoma who had received bone marrow stem cell transplants.
In a bone marrow transplant, the patients' own bone marrow is destroyed, usually with chemotherapy or radiation, and replaced with a tissue-matched transplant from a donor.
Kuritzkes, Henrich and colleagues wanted to replicate the case of Timothy Brown, also known as the "Berlin patient," who was treated for leukemia with a bone marrow transplant that happened to come from a donor with a genetic mutation that makes immune cells resist HIV infection. The transplant replaced his own infected cells with healthy, AIDS-resistant cells, and he remains free of the virus more than five years later.
Then there is the widely reported case of a baby in Mississippi whose HIV infection disappeared after unusually early and aggressive drug treatment.
The human immunodeficiency virus that causes AIDS is transmitted sexually, in blood, on infected needles, at birth and in breast milk.
HIV drugs called antiretroviral therapy can keep the virus suppressed to such low levels that patients are healthy and their immune systems are not damaged. People taking the drugs are also less likely to infect someone else, and studies show that uninfected people who take them are much less likely to become infected.
Doctors had hoped that if patients got bone marrow transplants while taking HIV drugs, the virus would not be able to take hold in the freshly transplanted bone marrow cells - which are the source of new blood cells.
It's not a lost cause, Kuritzkes said.
“We are continuing to recruit patients into the study,” Kuritzkes said. He said several patients who have been treated for cancer are being studied. It might be that people who weren’t infected with HIV as long before they got treated might be easier to “cure.”
“It’s not a reason to give up research on a cure,” he said.
First published December 9 2013, 7:17 AM