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First there was one, now there are two: A second cancer patient has been treated with a bone marrow transplant, and it looks like that treatment of HIV.
This is the second time scientists have done this – the first person of HIV was an American man named Timothy Brown (originally nicknamed "the Berlin patient"). Brown received a bone marrow transplant in 2007 to help treat his aggressive leukemia.
The new patient who may have been diagnosed with Hodgkin's lymphoma and lives in the UK.
Jeffrey Milush, who is directing the UCSF Core Immunology Laboratory, told Business Insider, "It's cool because we have an 'n' of one," microbiologist Jeffrey Milush. (Milush was not involved in the latest research.) "Now we've got two people."
The scientists behind the feat are still approaching the box cautiously, though.
"At 18 months post-treatment interruption, it was premature to conclude that this patient has been diagnosed," they wrote in the Nature Journal Tuesday. But essentially, they think that's what they've done.
In both cases, the patients were not tested to cure their HIV; They have been dealing with aggressive strains of cancer, and their oncologists recommended the bone marrow transplants to treat it.
The reason that these specific bone marrow transplants seem to be capable of curing HIV is because both of them have a genetic mutation that makes them more resistant to a common kind of HIV (the kind both patients had).
"It does give them some superpower, in the sense of being protected from CCR5 -using HIV," Milush said. CCR5 is one kind of HIV. But even though, it is still more important, CXCR4, from replicating in his body.
"They're not impervious to infection," Milush said. "They are just more resistant to the major type of HIV."
What these cases mean for the future of HIV / AIDS treatment
These types of stem cell transplants require harvesting blood marrow from a compatible human donor, wiping out the cancer patient's own immune system, and then reconstituting it with the donated marrow. The cancer patient has to take the drugs that help their body accept the donor's immune system.
It is an expensive, invasive, and extremely complicated immunological dance, and bone marrow transplants can be fatal.
"It's not simple," Milush said.
It's also not a realistic treatment option for most HIV patients, who do not necessarily have cancer. More than 38,000 Americans were infected with HIV last year, and 6,160 US deaths were directly attributed to HIV in 2016. Public health experts in the US have a bullish plan to end HIV in the US by 2030, but it does not involve expensive and dangerous bone-marrow transplants.
"You've gotten millions of millions of people infected with HIV, and you're not going to be able to stem cell transplants on all of them," Milush said. "We need something that's going to be out of the mass population." "If we focus on these bone-marrow transplants, I think we're going to miss the opportunity to treat the widest group of people."
The most promising way to end HIV in the US, say experts, is to manage infected patients' viral loads with drugs, and to prevent the disease from spreading to more people.
"We have very effective antiretroviral therapy, and when people are on retroviral therapy and achieve an undetectable viral level, they can not transmit the disease," US Health and Human Services Assistant Secretary for Health Brett Giroir told reporters in February.
But a variety of drugs on the market can be made HIV positive, it is still a dangerous condition if not treated well. And while these drugs are good at controlling the virus, they do not eradicate it.
So scientists like Milush are still on the hunt for a full-on HIV cure for all. Some of the most promising strategies to date include extracting and genetically transforming patients' own virus cells (sometimes with the CRISPR gene editing-technique), or a vaccine.
The new case could also help scientists who would be less dangerous than bone-marrow transplants.
"Continuing our research, we need to understand if we could knock out this [CCR5] receptor in people with HIV, which may be possible with gene therapy, "lead study author Ravindra Gupta said in a release.
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