This is not, in any way, a 'clean' blog. But I cannot type my genuine reaction to this news:
Shift of HIV Tropism in Stem-Cell Transplantation with CCR5 Delta32 Mutation
I have not stopped cussing since I heard about this.
God dammit, HIV.
We had ONE THING.
ONE THING that WORKED to CURE HIV.
And it has been taken away, in a very big way.
A long time ago in a galaxy far far away, we cured one man of HIV infection (more, more, more). You might know him as 'The Berlin Patient'. Long story short, he got a blood cancer, got a bone marrow transplant from someone who was homozygous delta32 (that is, their cells totally lack one of the receptors HIV likes to infect cells). Radiation/Chemo killed most of the latent HIV infected cells, and the few surviving latent cells released virus... that had no where to go (they could not infect the 'new' immune cells from the delta32 donor).
Amazing, wonderful, limited applicability, though. Homozygous delta32 bone marrow donors are few and far between, and bone marrow transplants are risky procedures. There is no way this kind of approach would be The Cure for HIV.
But it did lead us down several promising new pathways for treatment, including genetically modifying peoples immune cells to be delta32 (even though the person wasnt born delta32).
In this case, a 27 year old man received a homozygous delta32 bone marrow transplant to treat his acute myeloid leukemia. This was The Right thing to do-- treat his cancer, and potentially cure him of HIV.
'Cure' is not what happened.
The opposite of 'cure' is what happened.
The HIV quasispecies in this particular patient had already evolved CXCR4 variants. Radiation/Chemo killed most of the HIV infected immune cells, and they were replaced with non-CCR5 cells.
Meaning that if any cells latently infected with CCR5 tropic viruses were left in his body, the CCR5 viruses would have no where to go.
And if any cells latently infected with CXCR4 tropic viruses were left in his body... they would have no competition.
The guys immune system would be their playground.
And CXCR4 viruses are *bastards*.
A year after the transplant that 'should have' cured him of HIV... the guy was dead from AIDS, induced by CXCR4 viruses, allowed to flourish after the delta32 transplant.
There are not enough cuss words in the history of man to express how upsetting this is.
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Why didn't antiretrovirals work? Was he too weak from the cancer to be taking them? Was it just confidence that this "cure" would work a second time?