Boston Globe (12.06.2013)
The Boston Globe reported that HIV has rebounded in two patients whom doctors had declared virus-free after having bone marrow transplants. Dr. Timothy Henrich, an infectious diseases associate physician at Brigham and Women’s Hospital, announced the preliminary findings at an international conference of AIDS researchers in Florida. Henrich explained that he released the findings prior to analyzing the results to notify others in the field as soon as possible.
Both patients had been HIV-positive for years and had received chemotherapy and other treatments as well as bone marrow transplants for Hodgkin’s lymphoma. They had agreed to stop using antiretrovirals to determine whether the drugs were responsible for the undetectable levels of HIV or whether the bone marrow transplant had fought off the virus. In July, after seven weeks without antiretirovirals for one patient and 15 weeks for the other, researchers reported no trace of virus. However, in August researchers detected HIV in one patient who resumed treatment, while the other patient chose to stay off medication. In November, after eight months of undetectable HIV, the second patient showed signs of the virus and the patient resumed treatment.
Henrich commented that the return of the virus meant that HIV has reservoirs hidden deeper in the body and that it is more persistent than realized. He suggested that researchers investigate deeper in other tissues such as the liver, intestines, and brain, for virus, but he acknowledged the difficulty and infrequency of removing tissue from these places.
An American patient, known as the “Berlin patient,” who received a bone marrow transplant for leukemia in Germany in 2009, seems to have been cured of HIV. This patient’s bone marrow transplant was from a donor with a rare gene mutation known as CCR5-delta32, which is believed to be resistant to HIV.
Henrich and colleagues are reviewing data to determine why one patient remained virus-free months longer than the other. The researchers plan to extend the study, enroll more HIV-infected individuals who have had bone marrow transplants, and search for signs of virus in additional tissues before allowing patients to stop their antiretrovirals.