An ongoing dialogue on HIV/AIDS, infectious diseases,
November 10th, 2008
Yes, Just a Case Report, but Incredibly Cool
At this year’s Retrovirus Conference (was it really this year’s conference, seems like much longer ago than that), there was a poster presentation summarizing a very unusual case. A man with HIV, stable on antiretroviral therapy, developed acute leukemia. He underwent an allogeneic bone marrow transplant — here’s the kicker — from a donor who was homozygous for the CCR5 delta 32 mutation. In other words, the donor’s CD4 cells were all but resistant to infection with CCR5-tropic virus.
All antiretrovirals were stopped at the time of transplant, and — amazingly — no rebound in HIV viremia occurred for a year. No virus found in plasma or PBMCs; no HIV found in bone marrow or in rectal biopsies. He remained HIV seropositive, but the virus was nowhere to be found.
When I presented this single case in summaries of the highlights of this year’s CROI, inevitably the response was astonishment, even though it was just one case. But then the case disappeared from view, and I don’t believe it has been published yet in a peer-reviewed journal.
Now the story has been updated in the Wall Street Journal — the patient is now off antivirals for over 600 days, still no virus rebound. Today it’s the most e-mailed piece in the Journal.
Just a hunch, but I think this is the closest thing we’ve come to a cure for HIV infection. Granted, it’s not practical to offer bone marrow transplants to the 33 million or so people infected with HIV in the world, never mind the difficulty of finding donors who are appropriate matches and have the delta 32 mutation (the mutation occurs in only approximately 5% of individuals, and is even rarer in persons of African and Asian descent).
Regardless, if ever there were a plausible target for gene therapy, the CCR5 delta 32 mutation seems like a great place to start.
13 Responses to “Yes, Just a Case Report, but Incredibly Cool”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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Interesting…
Could not have been an autologous transplant. That means it was his own marrow.
>>Could not have been an autologous transplant.
Indeed, my error! I’ve corrected.
Extremely interesting.Ray of hope for millions.
it needs aggressive and vigorous exploration as it could life saving in an enviroment like the one i work with a prevalence rate of 15% and as many as 70000 deaths in 2005.
Pls share more information when available.
Thank you.
Is there any problemassociated with this mutation other than an advantage? What else does this gene ecnode for?
>>Is there any problemassociated with this mutation other than an advantage? What else does this gene encode for?
CCR5 delta 32 mutation is linked to more severe West Nile Virus infections, as well as tickborne encephalitis. Here’s a nice recent review:
http://www.journals.uchicago.edu/doi/full/10.1086/524692
This is fascinating and shows the important role of anecdotal evidence in and individual case presentations in advancing medicine — especially in retroviral medicine. I hope these findings have been published for all to access?
Miriam Kingsley
In-house Editor – Cases
Case Reports Ltd
Middlesex House
34-42 Cleveland Street
London W1T 4LB, UK
http://www.jmedicalcasereports.com
http://www.casesjournal.com
Not published yet (per PubMed) as far as I know. Agree it would be optimal to see it in a peer-reviewed journal.
Exactly the type of serendipitous information that may be able to lead to new discoveries and technologies. I certainly hope that is the case here. Be sure to forward this to Anthony Fauci! Thank you for your enthusiasm and dedication.
PWA in Kansas
Another cases are reported?
>>Another cases are reported?
I don’t believe so. There has been a prior case of someone who apparently “cleared” HIV after a bone marrow transplant, but the patient ended up dying of some other cause. Am speaking only on my vague memory of the case (sorry), but I believe it was done so long ago that our techniques to look for the virus would have been too crude at that time to say definitively that HIV was erradicated. Certainly the CCR5 story had not yet been described.
Do we are initiating a genome modification therapy for the “cure” or in the future we will be able to introduce only the genome modificator insted all the durg store . This wil not be by serendipitoius