6 ms·

This is using a stem cell transplant again like the first person which carries a high risk of lifelong complications and death. While awesome, this is not a rea

This is using a stem cell transplant again like the first person which carries a high risk of lifelong complications and death. While awesome, this is not a realistic or great option for patients without another issue needing a stem cell transplant. With modern HAART therapy one is expected to live as long as the average non-HIV infected patient in the US.

fastball 8y ago
HIV is still transmissible even with HAART therapy, so I'm not sure how it's relevant to the discussion of a cure.
- woofyman 8y ago
  Undetectable also means non transmissible.
  - toomuchtodo 8y ago
    Bold claim. How recent are HPV tests? Edit: While my comment came from caution due to historical human hubris, it appears I am wrong: “According to the Centers for Disease Control and Prevention (CDC), a person with an undetectable viral load has “effectively no risk” of sexually transmitting HIV. In 2016, the Prevention Access Campaign launched the U=U, or Undetectable = Untransmittable, campaign.”
    - pryce 8y ago
      That claim isn't a bold assessment of the medical literature at all, it's actually widely held to by the medical organizations responsible for HIV treatment and prevention. Here [1] is for instance an article referencing this claim, describing it as "based on strong scientific evidence" that was peer reviewed published by the journal of the American Medical Association. (EDIT: it's important to add the caveat, which is that this claim is about sexual transmission only, and does not cover pregnant-mother-to-child transmission or intravenous needle sharing). Also your comment now refers to "HPV" which is the name of a different disease. [1] https://jamanetwork.com/journals/jama/article-abstract/2720997 https://jamanetwork.com/journals/jama/article-abstract/27209...
      - toomuchtodo 8y ago
        I refer to HPV as a case study in humans not having tests available for a communicable disease (no HPV test exists for men) and underestimating it’s communicability (not to mention it’s role in causing several types of cancer). Apologies if you thought I was confusing HPV and HIV. Too often we think we’re smarter than we are, and the consequences can be damning. Hence why I said its a bold claim that undetectable means it can’t be transmitted. Are we absolutely sure? Because if we’re not, someone could acquire a life long chronic disease that would otherwise have been preventable. But the CDC says undetectable says no transmission; I hope they’re right in 100% of transmission scenarios.
    - woofyman 8y ago
      It’s the CDCs claim. https://www.healthline.com/health/hiv-aids/undetectable-viral-load-transmission-risk https://www.healthline.com/health/hiv-aids/undetectable-vira...
  - fastball 8y ago
    Being on HAART does not guarantee an undetectable viral load.
- pryce 8y ago
  HIV transmissibility relates to whether someone has been on HAART therapy and in compliance with that therapy long enough so that their measured viral load as been assessed and has dropped below a particular threshold. Transmissibility also relates to transmission vectors: eg vaginal or anal intercourse, sharing needles with intravenous drugs, and infected-mother-to-child routes (eg placental and/or breastfeeding). In particular the "Undetectable = Untransmissible" claim is (as I understand it) a claim specifically about transmission through vaginal and anal intercourse.
- barry-cotter 8y ago
  HIV isn’t actually that contagious unless you’re the receptive partner in anal sex or have direct blood borne infection as with sharing infected needles so reducing the viral load to less than 1/10,000th of normal should make getting infected a risk on par with getting hit by lightning. > Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis > Results: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19–1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person- years, and 0.16 (95% CI 0.02–1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse. > Conclusion: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART. ... > Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda > RESULTS The mean frequency of intercourse was 8.9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0.0011 (95% CI 0.0008-0.0015). Transmission probabilities increased from 0.0001 per act at viral loads of less than 1700 copies/mL to 0.0023 per act at 38 500 copies/mL or more (p=0.002), and were 0.0041 with genital ulceration versus 0.0011 without (p=0.02). Transmission probabilities per act did not differ significantly by HIV-1 subtypes A and D, sex, STDs, or symptoms of discharge or dysuria in the HIV-1-positive partner. INTERPRETATION Higher viral load and genital ulceration are the main determinants of HIV-1 transmission per coital act in this Ugandan population.
jdreyfuss 8y ago
The article says as much. The takeaway isn't that bone-marrow transplants should replace today's standard courses of treatment, but rather the fact that there's been a second instance of such a cure means that there's hopefully some signal here that can eventually be leveraged in finding a more workable cure
- maxerickson 8y ago
  Does destroying all the possible reservoir cells really point to incremental possibilities?
  - deleted 8y ago
    [deleted]
  - carbocation 8y ago
    I think so. I'm cynical, and might wonder whether it's truly possible to eradicate such a reservoir. Seeing a couple examples that prove my intuition wrong is very powerful.
- interestica 8y ago
  And specifically this time it did not need to nearly kill the patient.
  - rincebrain 8y ago
    [1] suggests he still got the fun host-versus-graft-disease, so it seems like he might still have had that nasty rollercoaster, unless you meant some other nearly-killed-the-patient. [1] - https://www.theguardian.com/society/2019/mar/05/london-patient-becomes-second-man-to-be-cleared-of-aids-virus https://www.theguardian.com/society/2019/mar/05/london-patie...
im3w1l 8y ago
We may see iterative improvements from here-on though.

fastball 8y ago

HIV is still transmissible even with HAART therapy, so I'm not sure how it's relevant to the discussion of a cure.

woofyman 8y ago
Undetectable also means non transmissible.
- toomuchtodo 8y ago
  Bold claim. How recent are HPV tests? Edit: While my comment came from caution due to historical human hubris, it appears I am wrong: “According to the Centers for Disease Control and Prevention (CDC), a person with an undetectable viral load has “effectively no risk” of sexually transmitting HIV. In 2016, the Prevention Access Campaign launched the U=U, or Undetectable = Untransmittable, campaign.”
  - pryce 8y ago
    That claim isn't a bold assessment of the medical literature at all, it's actually widely held to by the medical organizations responsible for HIV treatment and prevention. Here [1] is for instance an article referencing this claim, describing it as "based on strong scientific evidence" that was peer reviewed published by the journal of the American Medical Association. (EDIT: it's important to add the caveat, which is that this claim is about sexual transmission only, and does not cover pregnant-mother-to-child transmission or intravenous needle sharing). Also your comment now refers to "HPV" which is the name of a different disease. [1] https://jamanetwork.com/journals/jama/article-abstract/2720997 https://jamanetwork.com/journals/jama/article-abstract/27209...
    - toomuchtodo 8y ago
      I refer to HPV as a case study in humans not having tests available for a communicable disease (no HPV test exists for men) and underestimating it’s communicability (not to mention it’s role in causing several types of cancer). Apologies if you thought I was confusing HPV and HIV. Too often we think we’re smarter than we are, and the consequences can be damning. Hence why I said its a bold claim that undetectable means it can’t be transmitted. Are we absolutely sure? Because if we’re not, someone could acquire a life long chronic disease that would otherwise have been preventable. But the CDC says undetectable says no transmission; I hope they’re right in 100% of transmission scenarios.
  - woofyman 8y ago
    It’s the CDCs claim. https://www.healthline.com/health/hiv-aids/undetectable-viral-load-transmission-risk https://www.healthline.com/health/hiv-aids/undetectable-vira...
- fastball 8y ago
  Being on HAART does not guarantee an undetectable viral load.
pryce 8y ago
HIV transmissibility relates to whether someone has been on HAART therapy and in compliance with that therapy long enough so that their measured viral load as been assessed and has dropped below a particular threshold. Transmissibility also relates to transmission vectors: eg vaginal or anal intercourse, sharing needles with intravenous drugs, and infected-mother-to-child routes (eg placental and/or breastfeeding). In particular the "Undetectable = Untransmissible" claim is (as I understand it) a claim specifically about transmission through vaginal and anal intercourse.
barry-cotter 8y ago
HIV isn’t actually that contagious unless you’re the receptive partner in anal sex or have direct blood borne infection as with sharing infected needles so reducing the viral load to less than 1/10,000th of normal should make getting infected a risk on par with getting hit by lightning. > Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis > Results: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19–1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person- years, and 0.16 (95% CI 0.02–1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse. > Conclusion: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART. ... > Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda > RESULTS The mean frequency of intercourse was 8.9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0.0011 (95% CI 0.0008-0.0015). Transmission probabilities increased from 0.0001 per act at viral loads of less than 1700 copies/mL to 0.0023 per act at 38 500 copies/mL or more (p=0.002), and were 0.0041 with genital ulceration versus 0.0011 without (p=0.02). Transmission probabilities per act did not differ significantly by HIV-1 subtypes A and D, sex, STDs, or symptoms of discharge or dysuria in the HIV-1-positive partner. INTERPRETATION Higher viral load and genital ulceration are the main determinants of HIV-1 transmission per coital act in this Ugandan population.

jdreyfuss 8y ago

The article says as much. The takeaway isn't that bone-marrow transplants should replace today's standard courses of treatment, but rather the fact that there's been a second instance of such a cure means that there's hopefully some signal here that can eventually be leveraged in finding a more workable cure

maxerickson 8y ago
Does destroying all the possible reservoir cells really point to incremental possibilities?
- deleted 8y ago
  [deleted]
- carbocation 8y ago
  I think so. I'm cynical, and might wonder whether it's truly possible to eradicate such a reservoir. Seeing a couple examples that prove my intuition wrong is very powerful.
interestica 8y ago
And specifically this time it did not need to nearly kill the patient.
- rincebrain 8y ago
  [1] suggests he still got the fun host-versus-graft-disease, so it seems like he might still have had that nasty rollercoaster, unless you meant some other nearly-killed-the-patient. [1] - https://www.theguardian.com/society/2019/mar/05/london-patient-becomes-second-man-to-be-cleared-of-aids-virus https://www.theguardian.com/society/2019/mar/05/london-patie...

im3w1l 8y ago

We may see iterative improvements from here-on though.