3 ms·

The Berlin Patient was an extremely unique case. 1) The patient had leukemia and HIV 2) The bone marrow donor had the extremely rare delta 32 mutation (which

The Berlin Patient was an extremely unique case. 1) The patient had leukemia and HIV 2) The bone marrow donor had the extremely rare delta 32 mutation (which provides resistance to HIV) Bone marrow donors are in high demand. The delta 32 mutation is extremely rare. Assuming there were not limitations on delta 32 bone marrow donors, it is not ethically sound to intentionally induce leukemia and/or perform transplants when there are already tested treatment methods (Antiretroviral drugs/tenofovir) that make HIV a manageable disease.

autokad 9y ago
you dont need to induce leukemia right? leukemia was the reason why the person needed a bone marrow transplant, but as far as I know it doesnt help in 'curing' HIV.
- alanfalcon 9y ago
  That’s why the grandparent said “and/or” there, with a bit of humor attached I imagine.
- spoondan 9y ago
  I believe the point was that HIV alone does not motivate a bone marrow transplant. There are people with more urgent need for transplants and not enough donations to serve that need. It goes without saying that it's unethical to motivate a bone marrow transplant for a person with HIV by giving them leukemia. I assume then that it was said either as a joke or just for the sake of completeness.
  - Diggity 9y ago
    Yes precisely
- Diggity 9y ago
  HIV is notable for its ability to create "hidden reservoirs". Some recent cure attempts have been aimed at intentionally "kicking" the hidden reservoirs in order to flush them out. For this reason I mentioned inducing leukemia as it would replicate the circumstances of the Berlin Patient. For additional follow up, there have been additional bone marrow transplant attempts in somewhat similar circumstances with bone marrow that did not contain the mutation. Further reading: Hidden reservoirs: https://www.nature.com/news/hidden-hiv-reservoirs-exposed-by-telltale-protein-1.21639 https://www.nature.com/news/hidden-hiv-reservoirs-exposed-by... The "Boston Patients": https://www.nature.com/news/hopes-of-hiv-cure-in-boston-patients-dashed-1.14324 https://www.nature.com/news/hopes-of-hiv-cure-in-boston-pati...
- dm319 9y ago
  Yes. Though an allogeneic (from another person) bone marrow transplant is a high risk procedure. Some will say up to a 30% treatment related mortality. You can cure Sickle cell disease as well with a transplant. Generally it isn't done because the risks are not worth curing a disease which has good treatment options (in HIV) or is generally a disease which can be symptomatically controlled in most patients.
matte_black 9y ago
What should one do if they have the delta 32 mutation?
abiox 9y ago
> it is not ethically sound to intentionally induce leukemia well, shucks. there goes my startup idea. :\
- TACIXAT 9y ago
  Don't let ethics stop you, follow your dreams.
  - weego 9y ago
    Everyone knows you can't ditch your ethics until Series C
nonbel 9y ago
>"extremely rare delta 32 mutation...delta 32 mutation is extremely rare...limitations on delta 32 bone marrow donors" What is your definition of "extremely rare"?
- Diggity 9y ago
  1% of Caucasian population (http://genetics.thetech.org/original_news/news13 http://genetics.thetech.org/original_news/news13)
  - asdfaefasdf 9y ago
    That's actually about 2x the population of the US with HIV. Relatively speaking, it's not that rare comparatively.
    - Diggity 9y ago
      If bone marrow donations for all caucasians were mandatory I would agree.
    - deleted 9y ago
      [deleted]
    - dm319 9y ago
      You also need them to be an HLA match as well as being on the bone marrow transplant register.
- forthefuture 9y ago
  1% of people have the mutation[1]. 25 million people are registered to donate bone marrow internationally[2]. That statistically represents 250,000 total cures available worldwide for the 36.7 million HIV sufferers[3]. Not taking into account the other ailments bone marrow transfers cure. [1] http://genetics.thetech.org/original_news/news13 http://genetics.thetech.org/original_news/news13 [2] https://bethematch.org/news/news-releases/international-marrow-donor-registries-reach-25-million-potential-donors--give-hope-to-searching-blood-cancer-patients-around-the-world/ https://bethematch.org/news/news-releases/international-marr... [3] https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics https://www.hiv.gov/hiv-basics/overview/data-and-trends/glob...
WhyNotHugo 9y ago
> it is not ethically sound to intentionally induce leukemia No okay to force it, but I see no reason why patients can't opt into (being made well aware of the risks, that is).
- downrightmike 9y ago
  Do no harm
craftyguy 9y ago
Well no shit. The point is to find the cause for curing him, not to convince others to approve of intentionally inducing leukemia in HIV patients to get them on the bone marrow transplant list. The hope is that it's possible to determine _what_ cured him so it could be possibly synthesized or extracted by other means that would not place additional strain on any transplant lists..

autokad 9y ago

you dont need to induce leukemia right? leukemia was the reason why the person needed a bone marrow transplant, but as far as I know it doesnt help in 'curing' HIV.

alanfalcon 9y ago
That’s why the grandparent said “and/or” there, with a bit of humor attached I imagine.
spoondan 9y ago
I believe the point was that HIV alone does not motivate a bone marrow transplant. There are people with more urgent need for transplants and not enough donations to serve that need. It goes without saying that it's unethical to motivate a bone marrow transplant for a person with HIV by giving them leukemia. I assume then that it was said either as a joke or just for the sake of completeness.
- Diggity 9y ago
  Yes precisely
Diggity 9y ago
HIV is notable for its ability to create "hidden reservoirs". Some recent cure attempts have been aimed at intentionally "kicking" the hidden reservoirs in order to flush them out. For this reason I mentioned inducing leukemia as it would replicate the circumstances of the Berlin Patient. For additional follow up, there have been additional bone marrow transplant attempts in somewhat similar circumstances with bone marrow that did not contain the mutation. Further reading: Hidden reservoirs: https://www.nature.com/news/hidden-hiv-reservoirs-exposed-by-telltale-protein-1.21639 https://www.nature.com/news/hidden-hiv-reservoirs-exposed-by... The "Boston Patients": https://www.nature.com/news/hopes-of-hiv-cure-in-boston-patients-dashed-1.14324 https://www.nature.com/news/hopes-of-hiv-cure-in-boston-pati...
dm319 9y ago
Yes. Though an allogeneic (from another person) bone marrow transplant is a high risk procedure. Some will say up to a 30% treatment related mortality. You can cure Sickle cell disease as well with a transplant. Generally it isn't done because the risks are not worth curing a disease which has good treatment options (in HIV) or is generally a disease which can be symptomatically controlled in most patients.

matte_black 9y ago

What should one do if they have the delta 32 mutation?

abiox 9y ago

> it is not ethically sound to intentionally induce leukemia well, shucks. there goes my startup idea. :\

TACIXAT 9y ago
Don't let ethics stop you, follow your dreams.
- weego 9y ago
  Everyone knows you can't ditch your ethics until Series C

nonbel 9y ago

>"extremely rare delta 32 mutation...delta 32 mutation is extremely rare...limitations on delta 32 bone marrow donors" What is your definition of "extremely rare"?

Diggity 9y ago
1% of Caucasian population (http://genetics.thetech.org/original_news/news13 http://genetics.thetech.org/original_news/news13)
- asdfaefasdf 9y ago
  That's actually about 2x the population of the US with HIV. Relatively speaking, it's not that rare comparatively.
  - Diggity 9y ago
    If bone marrow donations for all caucasians were mandatory I would agree.
  - deleted 9y ago
    [deleted]
  - dm319 9y ago
    You also need them to be an HLA match as well as being on the bone marrow transplant register.
forthefuture 9y ago
1% of people have the mutation[1]. 25 million people are registered to donate bone marrow internationally[2]. That statistically represents 250,000 total cures available worldwide for the 36.7 million HIV sufferers[3]. Not taking into account the other ailments bone marrow transfers cure. [1] http://genetics.thetech.org/original_news/news13 http://genetics.thetech.org/original_news/news13 [2] https://bethematch.org/news/news-releases/international-marrow-donor-registries-reach-25-million-potential-donors--give-hope-to-searching-blood-cancer-patients-around-the-world/ https://bethematch.org/news/news-releases/international-marr... [3] https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics https://www.hiv.gov/hiv-basics/overview/data-and-trends/glob...

WhyNotHugo 9y ago

> it is not ethically sound to intentionally induce leukemia No okay to force it, but I see no reason why patients can't opt into (being made well aware of the risks, that is).

downrightmike 9y ago
Do no harm

craftyguy 9y ago

Well no shit. The point is to find the cause for curing him, not to convince others to approve of intentionally inducing leukemia in HIV patients to get them on the bone marrow transplant list. The hope is that it's possible to determine _what_ cured him so it could be possibly synthesized or extracted by other means that would not place additional strain on any transplant lists..