By DONALD G. McNEIL Jr.
December 6, 2013
Two patients in Boston whom doctors
hoped they had cured of both H.I.V. and
cancer through bone-marrow transplants
have seen their H.I.V. return, researchers
said Friday.
Although there was never an expectation
that risky bone-marrow transplants would
soon be a routine treatment for H.I.V., the
news was frustrating to AIDS experts.
Many had hoped that the “graft versus
host” battle that virtually all such
transplants set off could become a potent
weapon, at least in a few high-risk cases.
In July, when the two cases were first
discussed at an international AIDS
conference, it was suggested that they
might echo the case of Timothy Ray
Brown, the famous “Berlin patient,” who
has been free of H.I.V. since a 2008 bone-
marrow transplant from a donor with a
rare mutation that confers resistance to
the virus. Some experts regard him as the
first patient cured of H.I.V.
The resurgence of the virus in the two
patients is “disappointing but scientifically
significant,” Dr. Timothy J. Henrich, who
oversees their care at Brigham and
Women’s Hospital in Boston, said in a
statement.
Dr. Timothy J. Henrich had warned in
July that H.I.V. in two men could return.
LAI SENG SIN / ASSOCIATED PRESS
Both men are back on antiretroviral drugs
and “in good health,” Dr. Henrich added.
Dr. Steven G. Deeks, an AIDS researcher
at the University of California, San
Francisco, called the results
“disappointing but not unexpected.” The
cases demonstrate that the virus can hide
so deeply in the body that it cannot be
detected by the most sophisticated lab
work.
“It just takes one virus in one cell,” he
said.
Dr. Anthony S. Fauci, the director of the
National Institute of Allergy and Infectious
Diseases, said the failure “doesn’t put an
end to this avenue of research, but it
certainly does put a damper on it.”
The two Boston men already had H.I.V.
when they developed lymphoma, a blood
cancer. Both kept taking antiretroviral
drugs for H.I.V. while their bone marrow
was weakened to prepare for the
transplants. They stayed on the drugs for
years afterward.
Mr. Brown, in Berlin, received marrow
from a donor with a rare mutation, known
as delta 32, that makes blood cells
virtually impervious to H.I.V. The Boston
men’s donors did not have the mutation;
they were simply good matches.
Dr. Henrich hoped that the new blood
cells from the new marrow would find and
kill all the old ones, which were both
cancerous and infected with H.I.V., and
that the antiretroviral drugs would protect
the new blood cells against H.I.V.
When no virus could be found in the men
for months, they stopped taking the
drugs.
In July, Dr. Henrich announced that one
man had been off the drugs for seven
weeks and the other for 15, and that no
virus had been found. (It normally returns
within a month or so.)
At that time, he and other researchers
referred to the men as being in remission,
not cured. But Dr. Henrich warned that
the virus “could come back in a week, or
in six months.”
On Friday, he said it had returned in one
man in August and in the other man last
month.
Apparently, Dr. Fauci said, either some
old infected cells survived or they infected
some new ones before succumbing.
While there may still be a way to make
bone-marrow transplants work with H.I.V.
patients, Dr. Fauci said, “it tells you for
sure that it’s not going to be easy.”
Source: http://mobile.nytimes.com/2013/12/07/health/marrow-transplants-fail-to-cure-two-hiv-patients.html?hpw=&rref=science&

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