[Diggity]

The Berlin Patient was an extremely unique case.

1) The patient had leukemia and HIV

2) The bone marrow donor had the extremely rare delta 32 mutation (which provides resistance to HIV)

Bone marrow donors are in high demand. The delta 32 mutation is extremely rare.

Assuming there were not limitations on delta 32 bone marrow donors, it is not ethically sound to intentionally induce leukemia and/or perform transplants when there are already tested treatment methods (Antiretroviral drugs/tenofovir) that make HIV a manageable disease.

[autokad]

you dont need to induce leukemia right? leukemia was the reason why the person needed a bone marrow transplant, but as far as I know it doesnt help in 'curing' HIV.

[spoondan]

I believe the point was that HIV alone does not motivate a bone marrow transplant. There are people with more urgent need for transplants and not enough donations to serve that need.

It goes without saying that it's unethical to motivate a bone marrow transplant for a person with HIV by giving them leukemia. I assume then that it was said either as a joke or just for the sake of completeness.

[Diggity]

Yes precisely

[Diggity]

HIV is notable for its ability to create "hidden reservoirs". Some recent cure attempts have been aimed at intentionally "kicking" the hidden reservoirs in order to flush them out. For this reason I mentioned inducing leukemia as it would replicate the circumstances of the Berlin Patient.

For additional follow up, there have been additional bone marrow transplant attempts in somewhat similar circumstances with bone marrow that did not contain the mutation.

Further reading:

Hidden reservoirs: https://www.nature.com/news/hidden-hiv-reservoirs-exposed-by...

The "Boston Patients": https://www.nature.com/news/hopes-of-hiv-cure-in-boston-pati...

[dm319]

Yes. Though an allogeneic (from another person) bone marrow transplant is a high risk procedure. Some will say up to a 30% treatment related mortality.

You can cure Sickle cell disease as well with a transplant. Generally it isn't done because the risks are not worth curing a disease which has good treatment options (in HIV) or is generally a disease which can be symptomatically controlled in most patients.

[alanfalcon]

That’s why the grandparent said “and/or” there, with a bit of humor attached I imagine.

[craftyguy]

Well no shit. The point is to find the cause for curing him, not to convince others to approve of intentionally inducing leukemia in HIV patients to get them on the bone marrow transplant list.

The hope is that it's possible to determine _what_ cured him so it could be possibly synthesized or extracted by other means that would not place additional strain on any transplant lists..

[abiox]

> it is not ethically sound to intentionally induce leukemia

well, shucks. there goes my startup idea. :\

[TACIXAT]

Don't let ethics stop you, follow your dreams.

[weego]

Everyone knows you can't ditch your ethics until Series C

[nonbel]

>"extremely rare delta 32 mutation...delta 32 mutation is extremely rare...limitations on delta 32 bone marrow donors"

What is your definition of "extremely rare"?

[forthefuture]

1% of people have the mutation[1]. 25 million people are registered to donate bone marrow internationally[2].

That statistically represents 250,000 total cures available worldwide for the 36.7 million HIV sufferers[3]. Not taking into account the other ailments bone marrow transfers cure.

[1] http://genetics.thetech.org/original_news/news13

[2] https://bethematch.org/news/news-releases/international-marr...

[3] https://www.hiv.gov/hiv-basics/overview/data-and-trends/glob...

[Diggity]

1% of Caucasian population

(http://genetics.thetech.org/original_news/news13)

[asdfaefasdf]

That's actually about 2x the population of the US with HIV. Relatively speaking, it's not that rare comparatively.

[Diggity]

If bone marrow donations for all caucasians were mandatory I would agree.

[dm319]

You also need them to be an HLA match as well as being on the bone marrow transplant register.

[adenadel]

According to Wikipedia (without a citation)

"CCR5 Δ32 has an (heterozygote) allele frequency of 10% in Europe, and a homozygote frequency of 1%."

[matte_black]

What should one do if they have the delta 32 mutation?

[WhyNotHugo]

> it is not ethically sound to intentionally induce leukemia

No okay to force it, but I see no reason why patients can't opt into (being made well aware of the risks, that is).

[downrightmike]

Do no harm