Two Boston patients whom doctors hoped they had cured of both HIV and cancer through bone-marrow transplants have seen their HIV return, researchers said Friday.
Although there was never an expectation that risky bone-marrow transplants would soon be a routine treatment for HIV, the news was frustrating to AIDS experts. Many had hoped 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 Seattle native Timothy Ray Brown, the famous “Berlin patient,” who has been free of HIV 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 HIV.
The resurgence of the virus in the two patients is “disappointing but scientifically significant,” said Dr. Timothy Henrich, who oversees their care at Brigham and Women’s Hospital in Boston.
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Both men are back on antiretroviral drugs and “in good health,” he added.
Dr. Steven 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 Fauci, 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 had HIV when they developed lymphoma, a blood cancer. Both kept taking antiretroviral drugs for HIV while their bone marrow was weakened to prepare for the transplants. They stayed on the drugs for years afterward.
Brown, in Berlin, received marrow from a donor with a rare mutation, delta 32, that makes blood cells virtually impervious to HIV. The Boston men’s donors did not have the mutation; they were simply good matches.
Henrich hoped the new blood cells from the new marrow would find and kill all the old ones, which were both cancerous and infected with HIV, and that the antiretroviral drugs would protect the new blood cells against HIV.
When no virus could be found in the men for months, they stopped taking the drugs.
In July, Henrich said one man had been off the drugs for seven weeks and the other for 15, and 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 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, 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 HIV patients, Fauci said: “It tells you for sure that it’s not going to be easy.”