Men “cured” of HIV by bone marrow transplant suffer relapse

Two patients from the US, who were thought to possibly have been cured of HIV, have relapsed.

These two men were both HIV positive and had lymphoma, a type of cancer. They both received bone marrow transplants. Post-transplant they continued on their antiretroviral medicine (used to combat HIV) while the donor bone marrow cells engrafted. Researchers found that all traces of HIV in the patients vanished.

They were followed and, in time, both patients stopped their antiretrovirals. They remained HIV free – or so everyone thought, since their viral loads were undetectable and no trace of HIV was found in peripheral blood cells.

Men thought “cured” of HIV, relapse

Unfortunately, over time, both relapsed and tests showed HIV was again (still) present.

HIV can lie dormant in some cell types, sometimes for years. Then, for some reason, the dormant HIV in some of these cells reactivates and causes the cells to produce new virus. That’s apparently what happened here. Some HIV infected cells remained and reactivated.  I’d written about this in more detail earlier:

A third impediment to finding a cure is that some virus can enter cells and remain dormant, sometimes for a very long time.

cdrin /

AIDS-HIV activist dispenses awareness information near Yoyogi Park, popular with teens and young adults on Sept. 18, 2009 in Tokyo. 20-30 year-olds have the highest rate of HIV in Japan. cdrin /

The HIV virus enters cells, transcribes its RNA into DNA, merges with the cell’s native DNA and waits. The virus has safely sequestered itself from the patient’s immune system and the ARV [antiretroviral] medications the patient is taking. It remains there, ready to become active at some future time. HIV can remain there, inactive and hidden, for a long time.  It is estimated that, based on the number of infected cells, the amount of virus present, nature of the ARVs used and other factors a patient would need to stay on ARVs for 70 years before all of the dormant virus activated and was subsequently destroyed.

While the patient remains on antiretroviral therapy the viral load may become undetectable. At times, in some cells, the viral DNA may become active again, even while on ARVs. The renewed activity will cause production of new virus that will be released into the circulation, and cause the death of the cell producing the virus. Once the HIV is free, however, the ARVs can work against it and neutralize it. But take the patient off of antiretroviral medications and, sooner or later, some viral DNA will activate and spread. And with no ARVs being present, more cells become infected and the viral load rises. Thus ARVs are thus not a cure for HIV, by themselves, because they don’t get at all the hidden virus.

Researchers will review this information, and this data may be useful in future research. Some other possible cures (“functional” cures) may have occurred using other methods.

HIV vaccine fraud

More bad news on the fight against HIV/AIDS. A researcher has been implicated in falsifying data in an HIV vaccine research project. Dr. Dong-Pyou Han, an assistant professor at Iowa State University, resigned his position there after an investigation showed that he deliberately falsified the results of experiments.

Han presented data that showed that the vaccine he was working on produced a significant antibody response in rabbits that were given the vaccine. However, over a few years’ time, other researchers were unable to reproduce the results and called his data into question. Apparently, Han added human HIV antibodies to the rabbit samples to make it look like the vaccine was working well and producing an excellent immune response in the rabbits. The rabbit samples were sent to another lab that tested them and found that they had indeed been “spiked” with foreign antibodies.

Upon investigation, Han appeared to be the likely suspect. When confronted, he confessed and submitted his resignation. The National Institutes of Health, which funded the research, will not permit Han to receive further grant funding from them for three years. (More on that wrist-slap in a moment.)

This research appeared promising enough that the NIH doled out almost $20 million dollars over several years to support it. The NIH can demand that the money be returned by ISU, though that rarely happens. Theoretically, the university is responsible for the quality of the research done by its faculty. Obviously, that would be an impossible task for any university. But the fault here seems to lie with only one researcher.

In addition to the fraud he committed, the research produced by Han was misleading. Other researchers may have tried to use his data in their research, and been hampered because it was altered. Not only did Han falsify his research, his actions may have caused delays or failures in others’ research, which cost valuable research dollars in addition to time.

A three-year ban on receiving funding from the NIH doesn’t seem like very much in the way of discipline. Perhaps, in cases like this, we ought to consider prosecuting the perpetrator, to the extent the law allows.  And if it doesn’t allow, perhaps the law should be changed.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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