Relapse of 'cured' HIV patients spurs AIDS science on

reuters.com ^ | Jan 2, 20114 | Kate Kelland

[ransomnote]

(Reuters) - Scientists seeking a cure for AIDS say they have been inspired, not crushed, by a major setback in which two HIV positive patients believed to have been cured found the virus re-invading their bodies once more.

True, the news hit hard last month that the so-called "Boston patients" - two men who received bone marrow transplants that appeared to rid them completely of the AIDS-causing virus - had relapsed and gone back onto antiretroviral treatment.

But experts say the disappointment could lay the basis for important leaps forward in the search for a cure.

"It's a setback for the patients, of course, but an advance for the field because the field has now gained a lot more knowledge," said Steven Deeks, a professor and HIV expert at the University of California, San Francisco.

He and other experts say the primary practical message is that current tests designed to detect even very low levels of HIV present in the body are simply not sensitive enough.

As well as having the human immunodeficiency virus (HIV), the Boston patients both also had a type of blood cancer called lymphoma, for which they were treated using bone marrow transplants - one man in 2008 and the other in 2010.

They continued taking the antiretroviral AIDS drugs, but eight months after each patient's transplant, doctors found they could not detect any sign of HIV in their blood.

In the early part of 2013, both patients decided to stop taking their AIDS drugs and both appeared to remain HIV-free - prompting their doctors, Timothy Henrich and Daniel Kuritzkes from Boston's Brigham and Women's Hospital, to announce at a conference in July that they may have been cured.

[trebb]

So might this indicate that the AIDS tests commonly in use are not sensitive enough to accurately report whether bone marrow donation or blood has the aids virus? Is it that they couldn't test in a system as complex as the human body? If so, wouldn't the tested population in the US actually have higher levels of aids than currently reported?

It might also mean that it doesn't take as high a concentration of the virus to infect someone - they thought there was a cure because they couldn't detect it and the undetectable amount was sufficient to reinfect. I wonder if there are other factors that occur with having been infected that make it easier for a smaller amount of the virus to propagate.

[Jim Noble]

I don’t think that either Steve Deeks or Dan Kuritzkes ever said anything other than “maybe” about these two.

And, yes, it’s quite significant, but not at all surprising, that a test cutoff of 20 copies per mL of blood is not sensitive enough to detect a very significant total body viral burden.