7 ms·

More HIV 'cured': first a baby, now 14 adults

182 points by danboarder 14y ago

danboarder 14y ago
"Last week, a baby was reported to have been 'functionally cured' of HIV after receiving a three-drug regime of ARVs almost immediately after birth." I'm curious about the qualifier "functionally cured" and what this means exactly. The basic idea I gather from the article is that unusually early drug treatments have been found to 'cure' people of HIV in this way, where they no longer need drug treatments.
- anigbrowl 14y ago
  It means they can't detect any HIV on repeated tests, but they don't know exactly what's going on so they're hedging in case they've overlooked something.
- dpeck 14y ago
  With the baby actually, from the NPR interview I listened to was that medication was given late. The mother did not know she was HIV positive until she was about to deliver so the preventative? medication wasn't given. Following that she was given very high dosage.
- InclinedPlane 14y ago
  "Curing" is proving a negative, it's hard, especially with a disease that has a long period of dormancy. Saying "they will never develop AIDS through their natural lifetime" would require waiting for a natural lifetime, which is rather a while. But we have a lot of technology that is capable of measuring viral load and so we can say that someone appears to be cured in that they do not show any viral activity over a significant period of time.
- tedivm 14y ago
  The hint is in what they said about the adults- >The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs. They still have HIV, and it may develop into AIDS again later. They can also still spread it, since they do have it in their system. They just don't have enough of it to cause them problems. With the baby there supposedly aren't any traces, but it's perfectly possible that there are still packets of the virus present. There is no definitive way to know the virus is completely gone and won't come back later.
  - pekk 14y ago
    So they feel great, don't need medical treatment, but can still spread it to others... so great, maybe here we go with AIDS becoming as common as the flu (and mutating more, and killing poor people who can't afford the expensive therapies)
    - shantanubala 14y ago
      Is there a reason why you think that? It will probably still be sexually transmitted (so it can be avoided more easily than the flu), and it already has a much worse impact on poorer communities. Also, you are assuming that the treatment will remain expensive forever and that there won't be any preventative treatments available in the future.
      - yk 14y ago
        Perhaps he is thinking of Gibsons's Bridge trilogy. There AIDS is cured by finding a variant of HIV which does not cause the disease. And at least in one scene it is implied that infection with the harmless variant is a usual prerequisite for casual sex.
    - nazgulnarsil 14y ago
      Just don't have sex with poor people. Ask to see some tax returns.
  - leoc 14y ago
    Sounds like the kind of latent illness that's likely to flare up again when you get old, or if you suffer another serious illness or injury.
  - gadders 14y ago
    Are they still infectious, do you know?
    - bobwaycott 14y ago
      I may be mistaken, but I believe the presence of HIV in their system means it is still transmissible. The article title is, unfortunately, misusing the word 'cure'.
- geuis 14y ago
  Lets use cancer terminology. The people's HIV is in remission. As with cancer, you can treat it to the point that its undetectable by current tests. Since a doctor may not be able to guarantee your cancer has been completely obliterated (all cancerous cells destroyed), you are in remission. I would look at this in the same way.
  - illuminate 14y ago
    It would be nice if persons used this analogy rather than 'cure'.
- tsotha 14y ago
  That baby may be actually cured because treatment may have started before the virus could establish a reservoir. The older people have just had their infection knocked down to a very low level. In theory you can be cured if you're treated as soon as you're exposed to the virus, but it's very, very rare that people know they've been exposed.
guelo 14y ago
> The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs. That doesn't sound like cured to me since they're probably still infectious even if they aren't getting sick from it.
- UnoriginalGuy 14y ago
  You aren't wrong, but by that logic are we ever really cured? I mean you "kill" cancer: But yet cancerous cells likely remain either in the general area of the tumour or in your blood stream. You get "cured" of a deadly disease, but many continue to remain in your body for sometimes the remainder of your life.
  - netrus 14y ago
    Yeah, but cancer is not infectious. People will always develop cancer, but we could potentially get to a point where nobody has HIV anymore, if we can prevent the virus from spreading.
    - geuis 14y ago
      Not disagreeing with you since as far as I know, there are no human cancers that are contagious. There are at least 2 mammalian cancers I know of, and possibly more, that are contagious. One is a disease wiping out Tasmanian devils. Another is a sexually transmitted cancer among dogs. Its thousands of years old and shows up as small tumors around the genital regions of affected animals. There was a TED talk describing this in some detail. Don't have the time to search for a link at the moment, but you can probably find it.
      - jeza 14y ago
        Well there's human papilloma virus (http://en.wikipedia.org/wiki/Human_papillomavirus http://en.wikipedia.org/wiki/Human_papillomavirus) which can result in the development of cervical cancer (http://en.wikipedia.org/wiki/Cervical_cancer http://en.wikipedia.org/wiki/Cervical_cancer).
p6v53as 14y ago
This is quite an achievement to go from no cure whatsoever, to a cure that works on 1% of people. Because now you don't need to look for things that works, you need to improve something you have.
tokenadult 14y ago
From the article: "Asier Sáez-Cirión of the Pasteur Institute's unit for regulation of retroviral infections in Paris analysed 70 people with HIV who had been treated with antiretroviral drugs (ARVs) between 35 days and 10 weeks after infection – much sooner than people are normally treated. . . . . "Most of the 70 people relapsed when their treatment was interrupted, with the virus rebounding rapidly to pre-treatment levels. But 14 of them – four women and 10 men – were able to stay off of ARVs without relapsing, having taken the drugs for an average of three years. . . . . "On average, the 14 adults have been off medication for seven years. One has gone 10-and-a-half years without drugs. 'It's not eradication, but they can clearly live without pills for a very long period of time,' says Sáez-Cirión." Any time I hear of someone not finding that an HIV infection turns into an early death after debilitating illness, I'm glad to hear the news. And if some commonality of those patients can be discovered that provides a clue how better to treat other patients, so much the better. But those odds (the majority of the patients who ceased treatment finding their infections rebounding back to acute clinical disease) are still discouraging. For AIDS, an ounce of prevention is still worth a pound of cure. The cases described here sound less like a "cure" than the case of the baby from Mississippi reported earlier, as these patients still have detectable HIV infections, just not infections currently resulting in clinical disease.
powertower 14y ago
"Functionally cured" is the key phrase in that article. They still have the HIV virus. But their immune system keeps it in check. That last part I don't understand. At that point, isn't it just a fine balance that can tip over at any point in the future, were the virus can come back stronger? Like if the person gets a cold, or the immune system get's weakened somehow (even for just a short time).
- alecdbrooks 14y ago
  I'm guessing the balance isn't that fragile because the people in question have had been drug-free for seven years on average. They must have had some minor illness during that time period.
carbocation 14y ago
These people are not cured. > The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs. For a transmissible infectious disease with a reservoir, cure means eradication. These people appear to have one of the following (just my guesses): 1) Early HAART led to selection pressure on HIV in such a way that, for some people, the HIV itself that became embedded in the latent reservoir is defective in some way. Therefore, the reservoir continues to produce HIV particles, but these are relatively ineffective at infecting additional cells. 2) They are supercontrollers via a previously undescribed mechanism (since they were stated not to be classical supercontrollers). Again, this is complete speculation that would require sequencing and functional studies to investigate, HIV is not my field, etc.
thedeepself 14y ago
HIV is a harmless retrovirus - Peter Duesberg, professor of molecular biology, UC Berkeley.
liquidcool 14y ago
This caused me to look up the Timothy Brown case, the man who was cured of AIDS via a bone marrow transplant for his leukemia with cells from a supercontroller. I get the concept of remission for the patients in the New Scientist article, but this article has Brown claiming he's completely cured: http://www.webmd.com/hiv-aids/news/20120724/man-cured-of-aids-virus-news-conference http://www.webmd.com/hiv-aids/news/20120724/man-cured-of-aid... If true, it gives hope that a complete cure is possible.

182 points by danboarder 14y ago

"Last week, a baby was reported to have been 'functionally cured' of HIV after receiving a three-drug regime of ARVs almost immediately after birth." I'm curious about the qualifier "functionally cured" and what this means exactly. The basic idea I gather from the article is that unusually early drug treatments have been found to 'cure' people of HIV in this way, where they no longer need drug treatments.

anigbrowl 14y ago
It means they can't detect any HIV on repeated tests, but they don't know exactly what's going on so they're hedging in case they've overlooked something.
dpeck 14y ago
With the baby actually, from the NPR interview I listened to was that medication was given late. The mother did not know she was HIV positive until she was about to deliver so the preventative? medication wasn't given. Following that she was given very high dosage.
InclinedPlane 14y ago
"Curing" is proving a negative, it's hard, especially with a disease that has a long period of dormancy. Saying "they will never develop AIDS through their natural lifetime" would require waiting for a natural lifetime, which is rather a while. But we have a lot of technology that is capable of measuring viral load and so we can say that someone appears to be cured in that they do not show any viral activity over a significant period of time.
tedivm 14y ago
The hint is in what they said about the adults- >The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs. They still have HIV, and it may develop into AIDS again later. They can also still spread it, since they do have it in their system. They just don't have enough of it to cause them problems. With the baby there supposedly aren't any traces, but it's perfectly possible that there are still packets of the virus present. There is no definitive way to know the virus is completely gone and won't come back later.
- pekk 14y ago
  So they feel great, don't need medical treatment, but can still spread it to others... so great, maybe here we go with AIDS becoming as common as the flu (and mutating more, and killing poor people who can't afford the expensive therapies)
  - shantanubala 14y ago
    Is there a reason why you think that? It will probably still be sexually transmitted (so it can be avoided more easily than the flu), and it already has a much worse impact on poorer communities. Also, you are assuming that the treatment will remain expensive forever and that there won't be any preventative treatments available in the future.
    - yk 14y ago
      Perhaps he is thinking of Gibsons's Bridge trilogy. There AIDS is cured by finding a variant of HIV which does not cause the disease. And at least in one scene it is implied that infection with the harmless variant is a usual prerequisite for casual sex.
  - nazgulnarsil 14y ago
    Just don't have sex with poor people. Ask to see some tax returns.
- leoc 14y ago
  Sounds like the kind of latent illness that's likely to flare up again when you get old, or if you suffer another serious illness or injury.
- gadders 14y ago
  Are they still infectious, do you know?
  - bobwaycott 14y ago
    I may be mistaken, but I believe the presence of HIV in their system means it is still transmissible. The article title is, unfortunately, misusing the word 'cure'.
geuis 14y ago
Lets use cancer terminology. The people's HIV is in remission. As with cancer, you can treat it to the point that its undetectable by current tests. Since a doctor may not be able to guarantee your cancer has been completely obliterated (all cancerous cells destroyed), you are in remission. I would look at this in the same way.
- illuminate 14y ago
  It would be nice if persons used this analogy rather than 'cure'.
tsotha 14y ago
That baby may be actually cured because treatment may have started before the virus could establish a reservoir. The older people have just had their infection knocked down to a very low level. In theory you can be cured if you're treated as soon as you're exposed to the virus, but it's very, very rare that people know they've been exposed.

guelo 14y ago

> The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs. That doesn't sound like cured to me since they're probably still infectious even if they aren't getting sick from it.

UnoriginalGuy 14y ago
You aren't wrong, but by that logic are we ever really cured? I mean you "kill" cancer: But yet cancerous cells likely remain either in the general area of the tumour or in your blood stream. You get "cured" of a deadly disease, but many continue to remain in your body for sometimes the remainder of your life.
- netrus 14y ago
  Yeah, but cancer is not infectious. People will always develop cancer, but we could potentially get to a point where nobody has HIV anymore, if we can prevent the virus from spreading.
  - geuis 14y ago
    Not disagreeing with you since as far as I know, there are no human cancers that are contagious. There are at least 2 mammalian cancers I know of, and possibly more, that are contagious. One is a disease wiping out Tasmanian devils. Another is a sexually transmitted cancer among dogs. Its thousands of years old and shows up as small tumors around the genital regions of affected animals. There was a TED talk describing this in some detail. Don't have the time to search for a link at the moment, but you can probably find it.
    - jeza 14y ago
      Well there's human papilloma virus (http://en.wikipedia.org/wiki/Human_papillomavirus http://en.wikipedia.org/wiki/Human_papillomavirus) which can result in the development of cervical cancer (http://en.wikipedia.org/wiki/Cervical_cancer http://en.wikipedia.org/wiki/Cervical_cancer).

p6v53as 14y ago

This is quite an achievement to go from no cure whatsoever, to a cure that works on 1% of people. Because now you don't need to look for things that works, you need to improve something you have.

tokenadult 14y ago

From the article: "Asier Sáez-Cirión of the Pasteur Institute's unit for regulation of retroviral infections in Paris analysed 70 people with HIV who had been treated with antiretroviral drugs (ARVs) between 35 days and 10 weeks after infection – much sooner than people are normally treated. . . . . "Most of the 70 people relapsed when their treatment was interrupted, with the virus rebounding rapidly to pre-treatment levels. But 14 of them – four women and 10 men – were able to stay off of ARVs without relapsing, having taken the drugs for an average of three years. . . . . "On average, the 14 adults have been off medication for seven years. One has gone 10-and-a-half years without drugs. 'It's not eradication, but they can clearly live without pills for a very long period of time,' says Sáez-Cirión." Any time I hear of someone not finding that an HIV infection turns into an early death after debilitating illness, I'm glad to hear the news. And if some commonality of those patients can be discovered that provides a clue how better to treat other patients, so much the better. But those odds (the majority of the patients who ceased treatment finding their infections rebounding back to acute clinical disease) are still discouraging. For AIDS, an ounce of prevention is still worth a pound of cure. The cases described here sound less like a "cure" than the case of the baby from Mississippi reported earlier, as these patients still have detectable HIV infections, just not infections currently resulting in clinical disease.

powertower 14y ago

"Functionally cured" is the key phrase in that article. They still have the HIV virus. But their immune system keeps it in check. That last part I don't understand. At that point, isn't it just a fine balance that can tip over at any point in the future, were the virus can come back stronger? Like if the person gets a cold, or the immune system get's weakened somehow (even for just a short time).

alecdbrooks 14y ago
I'm guessing the balance isn't that fragile because the people in question have had been drug-free for seven years on average. They must have had some minor illness during that time period.

carbocation 14y ago

These people are not cured. > The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs. For a transmissible infectious disease with a reservoir, cure means eradication. These people appear to have one of the following (just my guesses): 1) Early HAART led to selection pressure on HIV in such a way that, for some people, the HIV itself that became embedded in the latent reservoir is defective in some way. Therefore, the reservoir continues to produce HIV particles, but these are relatively ineffective at infecting additional cells. 2) They are supercontrollers via a previously undescribed mechanism (since they were stated not to be classical supercontrollers). Again, this is complete speculation that would require sequencing and functional studies to investigate, HIV is not my field, etc.

thedeepself 14y ago

HIV is a harmless retrovirus - Peter Duesberg, professor of molecular biology, UC Berkeley.

liquidcool 14y ago

This caused me to look up the Timothy Brown case, the man who was cured of AIDS via a bone marrow transplant for his leukemia with cells from a supercontroller. I get the concept of remission for the patients in the New Scientist article, but this article has Brown claiming he's completely cured: http://www.webmd.com/hiv-aids/news/20120724/man-cured-of-aids-virus-news-conference http://www.webmd.com/hiv-aids/news/20120724/man-cured-of-aid... If true, it gives hope that a complete cure is possible.