If this doesn't turn out to be overblown sensationalism, then the team behind this (actual!) cure probably deserves a Nobel for their efforts and results.
They don't deserve a Nobel because the idea has been obvious in medicine for years. They just got very lucky in being able to deliver a confirmed CCR5 delta 32+ bone marrow transplant to someone with HIV in a medically responsible way.
Curing HIV is an incredible thing to have accomplished but the confirmation of a successful surgery from 3 years ago doesn't advance the bounds of scientific knowledge as much as it was might seem when you see a story like this in the news.
> They don't deserve a Nobel because the idea has been obvious in medicine for years.
What's your science background/what's your degree in? This really wasn't obvious. It was an open question as to whether or not other cells that were latently infected could produce a new infection via the other co-receptor (CXCR4).
> They just got very lucky
To characterize their hard work as luck is unjust. Yes, patients don't always survive bone marrow transplants, and this patient is indeed lucky to have survived. But the dilligent effort of his physicians is deliberate! Remember that they had to screen a lot of potential donors (61, I believe) to find someone with enough HLA similarity and a homozygous CCR5delta32 genotype. You can call this luck, but it's really just hard and dilligent work. Out of a pool of around 60 million people (worldwide) homozygous for CCR5delta32, you can find someone with enough matching allotypes. (You do know that you don't need all of the allotypes to match, right? That increases the probablity right there. In some cases, a little imperfect matching is a good thing, because the resulting graft-vs-host effect can act against the cancer you're trying to treat. Doctors have been using this effect since the 80s.)
It's real, but not practical. The risk of death during a transplant like this is as high as 10%, because it involves completely knocking out the immune system.
I suspect that the mortality rate would be much lower amongst patients being treated for HIV. Bone marrow transplants as a therapy for leukemia requires killing the existing cells with radiation. This is completely sensible -- you've got some cancerous cells, so nuke everything and start over from the beginning.
Confounding the mortality stats is the fact that individuals undergoing treatment are very sick from the start. We might see better survival rates amongst comparatively healthy people.
In this case, you don't necessarily need a clean slate. "All" you need is a population of cells generating HIV resistant T-cells. AIDS manifests in individuals with extremely low T-cell counts. If a population of CD4 mutants could take hold within a larger population, it might be enough to prevent AIDS and bring viral titers low enough to eliminate transmission.
Nevertheless, I agree -- it's hardly practical, but it may be a beachhead.
I read an article back a few years, about how when they do a normal organ transplant (like a kidney) the patient benefits enormously from also getting a bone marrow transplant from the same donor. For a transplant you shut down the immune system completely, and keep it in a subdued state forever afterwards. With the matching bone marrow they could re-start the immune system to a mixed state afterwards, that accepted the original organs and the donation.
Anybody remember that article? I'd like to find it again.
AIDS has actually become manageable, and most HIV+ patients in the developed world die of other causes (cancer, aging, etc.) instead of AIDS. So I wouldn't be too sure.
That depends on what exactly manageable means and what the risks of the cure are. The choice seems by no means obvious to me.
Here is a hypothetical example (because I don’t know much about HIV): Getting rid of frequent headaches (the hypothetical side-effect of managing a hypothetical otherwise deadly disease) with a cure that has a 1:5 chance of death doesn’t seem like a good deal to me.
You're right. The article implies no side effects other than the strict (even aggressive, if you will) treatment regiment, which does seem somewhat fishy.
HIV may not be a death sentence anymore, but it's still a serious disease with profound implications in one's lifestyle, and as far as I'm concerned, a cure can't come soon enough.
No, patients do not have this choice because no licensed physician would give them said choice. People here are talking as if BMT were this mundane thing that you can just decide you want to do some afternoon.
I'm not really sure what's the point you're trying to make. Bone marrow transplants are not some unproven treatment. Stem cell research generally seems troubling to some politicians; this specific application is probably not approved but I don't see any reason why it shouldn't be in the near future.
Presumably that risk could be mitigated with improved processes (vacuum room?). If I read correctly, this was extreme application of an existing technique (chemotherapy).
Admittedly this is pretty intense, but so are treatments for cancer. Let's hope this leads to improved and safer treatments in the future.
Specifically, its businesses and citizens'll be doing just fine.
The government will probably be fucked up. But when was the last time it /wasn't/? I suspect even the older of HN's community'd really have to dig at their memories to remember a time when Cali's government was functioning at or near spec, regardless of party-in-power. We're pretty good at the whole revenue-generating shtick, but the governance bit seems to keep eluding us.
No I don't feel lucky, I just know that people like the fear leader are addicted to power and would loose a lot if they die or their country becomes a ruin.
I'm only guessing here, not being an engineer or a mathematician, but... wouldn't that be rather dependent on what kind of engineering you're getting into?
...why would it NOT be okay? Startups might need cash, but so do big corps. If we're talking about "donating equivalent to big corporations," then obviously we're talking flights of fancy. But we're not. I'm sure there's tax incentives for it; you've alluded to marketing incentives. But in the end, it's just a matter of whether or not the startup thinks it's financially in a place to do a little good.
Penny Arcade's got a staff size you can count on one hand; they run one of the best-known charities in gaming circles. They're not a Big Co. by any account, even if they've since developed Significant cultural presence.
That's still model-dependent, I think. If the cost is sufficient barrier to entry that user skepticism remains high, then you'd probably have less initial converts simply by having a smaller pool of potential clients giving you a chance.
