Top 10 HIV Clinical Developments of 2008 - CD8 T cells - The Body

22 • HIV JournalView—Top 10 HIV Clinical Developments of 2008
FIGURE 8
early in the course of HIV infection, those attempting to
rid the body of the virus have tried to either cajole the
virus from its sanctuaries or kill it along with the cells in
which it hides. Some will recall the 1980s-era reports of
bone marrow transplantation and the eradication of HIV;
however, techniques for the detection of the virus were
less sophisticated then and the death of patients soon after
the bone marrow transplant denied opportunities for
long-term follow-up. 25,26 The interesting combination of
Study Snapshot: HIV Treatment by Stem Cell Transplant
Design: Case study.
cytotoxic therapy and the replacement of bone
marrow stem cells with CCR5-deficient mutants,
in this case, is what is novel and most tantalizing.
Clearly, given the cost and the high risk of
life-threatening complications, stem cell
transplantation is not the HIV cure we need,
or want. For one thing, one third of patients
undergoing the procedure die. However, the
results suggest that less dramatic and risky
interventions are well worth exploring; these
include such things as gene therapy to alter
lymphocyte co-receptor expression.
In addition to the excitement that this case has
generated among patients and their advocates,
this report also is noteworthy for the innovative
and creative thinking of the physicians involved.
It was a masterstroke of an idea to search for
a CCR5-delta 32 marrow donor. I would like
to think that I too would have thought of this in the same
situation. But, I also like to think I have a full head of hair
(I don’t), am good with money (I’m not) and have kept
my youthful attractiveness (you be the judge). These
clinicians and their patient deserve admiration for a wellconsidered,
inspired and courageous choice that just
might provide the keyhole through which an accessible
cure for HIV can be glimpsed. ª
Population: 40-year-old man in Germany with HIV-1 infection since 1995 having a relapse of acute myeloid leukemia, first
diagnosed in 2006.
Main Results: More than 600 days post-transplant, the patient has undetectable levels of HIV in his peripheral blood, bone
marrow and rectal mucosa. The patient’s CD4+ cells continue to be absent CCR5 receptors.
Significance: Given the cost and the high risk of life-threatening complications, stem cell transplantation is not the HIV cure we
need, or want. However, results suggest that less dramatic and risky interventions are well worth exploring; these include such
things as gene therapy to alter lymphocyte co-receptor expression.