Many ERV readers are aware of ‘The Berlin Patient’– The fellow who has seemingly cleared the HIV-1 virus after receiving a bone marrow transplant to treat his lymphoma (we say ‘seemingly’ because we dont really know what ‘cured’ is with HIV yet).

The Berlin Patient was a rather unique case  in that he got a transplant from someone who is CCR5 negative.  CCR5 is the dominant co-receptor HIV-1 uses to infect host cells.  The idea was, if most of the patients HIV-susceptible cells were killed with radiation/chemo, and they were replaced with donor cells that lacked CCR5, then any virus remaining in the patient would have nowhere to go, and the patient would be, essentially, ‘cured’.

And he is, essentially.

There are many problems with this approach as a ‘cure’ for HIV/AIDS, however.  The first hurdle is that the patient has to be dying from leukemia/lymphoma.  No physician would do a bone marrow transplant on someone for HIV/AIDS only.  The second hurdle is that in addition to finding a proper immunological ‘match’ for donation, that donor must also be CCR5 negative.  Very few people, usually of a similar genetic descent, thus similar MHC type, are CCR5 negative, which would leave swaths of individuals who might have HIV and blood cancers, but you could not find them a proper ‘match’ who was CCR5 negative.

Apparently, some physicians have tried something that has addressed that second point–

• Two more men with HIV now virus-free. Is this a cure?
• Small breakthroughs offer big hope of AIDS ‘cure’

According to some media reports last night, two more HIV-1 patients have been cured-ish in a manner similar-ish to the Berlin Patient.  Kind of.  Maybe.

These two patients developed lymphomas that required treatment.  But they got regular ol bone marrow transplants from regular donors.  NOT CCR5 negative donors.  Im assuming that under ‘normal’ circumstances, antiretroviral treatment is stopped during cancer treatment.  Both protocols are rough on the patient, and you worry about the one that is going to kill them first, first– the cancer.

These two patients physicians had them stay on antiretrovirals over the course of their chemo/radiation/treatment.  The idea being that the radiation/chemo would kill most of the infected cells, antiretrovirals would inhibit viral release from the remaining reservoirs, and the donor cells– fresh, healthy, and a little pissed off immune cells– would clean up whatever was left over.

It looks like this protocol worked.

One patient has had no detectable virus or antibodies to the virus for two years so far, the other three and a half years.

Now, I know as much about what happened here as you do from reading media reports.  This has not been published in a journal– only reported at a conference yesterday.  There might be lots of caveats to this procedure.  Maybe these cancers were caught very early, and could be treated with a simpler/shorter regimen.  Maybe these patients were controlling HIV very well to begin with, low fitness virus, low viral loads, maybe even without antiretrovirals, and the radiation/chemo was enough to drive the virus to extinction in them, but it wouldnt work in someone infected with a more aggressive variant (one of the media reports that one of the patients has been infected since the 1980s– the beginning of the epidemic. if he is still around, it does make me think that he was infected with a low-fitness variant).  Both of the patients were themselves CCR5 negative, so again, the virus in them was ‘different’.

This might be GREAT news for some patients, and a functionally useless development for most.  But no doubt about it, its pretty damn awesome for at least two people.