German doctor finds potential cure for AIDS

A 42-year-old American man living in Germany may have been cured of both his leukemia and AIDS by a special bone marrow transplant he received to treat his leukemia. 

Dr. Gero Hütter of Germany stumbled upon the discovery after his patient failed to respond to chemotherapy in 2006. The second attempt at treating his patient’s leukemia was a bone-marrow transplant, but Hütter kept something else in mind when looking for a bone
marrow match. 

While looking for a bone marrow match, doctors also looked for a match with a rare genetic mutation referred to as a Delta 32 deletion. The mutation prevents a molecule called CCR5 from appearing on the surface of cells. CCR5 is a sort of door for the HIV virus and without it, most strains of the virus cannot bind to the cells.

This extremely rare mutation must be inherited from both parents and is found most often in people of European descent.    

From a pool of 80 compatible donors, Dr. Hütter’s colleague found a match with the rare mutation on the 61st sample. 

The next step was to prepare the patient for the transplant, which can be highly dangerous, especially for a patient with AIDS.  The patient had to take powerful drugs and was subject to radiation to wipe out his immune system, including his bone marrow. The procedure in itself is lethal to many of the cells that carry HIV and may have been a factor in helping the
treatment succeed. 

After the transfusion of the donor cells, the transplant specialists ordered the patient to stop taking AIDS medications in order to ensure the survival of the new cells. The original plan was to restart the AIDS medication regime after the HIV re-emerged, but that never happened. 

Two years later, the patient is still free of the virus. Standard testing has not found the virus in the blood, brain or rectal tissues, where it often hides. 

Although the virus cannot be detected in the patient, many researchers believe the virus may still lurk within the patient’s body, but since the new cells are invulnerable to the virus, the virus cannot start an infection. Technically speaking, the patient is considered “functionally cured.”

Dr. Judith Feinberg of the University of Cincinnati’s Infectious Diseases department and director of the AIDS Clinical Trials Unit, is cautious to call the patient cured as well.

“Maybe he was cured,” Dr. Feinberg said. “The issue is we know that when people first get infected, there are cells that live a very long time in your body that get infected, and they may have not completely cleared out those cells.”   

The medical discoveries do not come without problems of their own. It is possible that HIV could evolve to overcome these mutations. 

Another problem includes the procedure of the bone marrow transplant itself, usually given to only late-stage cancer patients. The procedure is extremely dangerous and highly lethal; 10 to 30 percent of the patients who undergo the treatment die.

“This isn’t a practical way of going around and treating HIV,” Feinberg said.  “He only got the transplant because he has leukemia.”  

While these findings mean there are great implications for the use of gene therapy to treat HIV, gene therapy has a downside because of complications that can arise. 

“There are already people who have been working on gene therapy that would have a similar approach,” Feinberg said. “Whether it’s going to work is up for grabs.”      

Feinberg also stressed that these findings do not mean that we will see some kind of new treatment or cure in the near future.

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