HIV Undetectable in 2 Men After Bone Marrow Transplants: Study

HealthDay – 1 hr 12 mins ago THURSDAY, July 26 (HealthDay News) -- Following bone marrow transplants, two men infected with HIV no longer have any traces of the AIDS-causing virus in their lymphocytes, researchers report.

Lymphocytes are a type of white blood cell and are a key part of the immune system.

The U.S. researchers suspect that bone marrow transplantation along with continuation of antiretroviral therapy resulted in the dramatic effects evident eight months post-transplant. They are scheduled to present these preliminary findings Thursday at the International AIDS Conference in Washington, D.C.

HIV patients on antiretroviral therapy often achieve "undetectable viral loads," meaning there are no virus particles in their blood. But they still have latent HIV in their lymphocytes, and if antiretroviral therapy were discontinued, the latent HIV could reactivate.

But having no traces of HIV in these white blood cells is an indication that this "reservoir" of latent HIV may have been eliminated, the researchers believe.

At this point, they are far from saying these patients are cured. But the findings are "exciting," said Dr. Savita Pahwa, director of the Center for AIDS Research at the University of Miami Miller School of Medicine, who was not involved with the study.

"Every hint you get that it's possible to wipe out the reservoir needs to be investigated," she said.

"Eliminating the reservoir is the key to the cure," said Pahwa. She also stressed that it would only be possible to say these patients were "functionally cured" if the virus did not rebound when the patients went off antiretroviral therapy.

The two men whose cases are described in the paper underwent chemotherapy for blood cancers before receiving stem cell transplants. One had his transplant two years ago; the other, four years ago. Both also developed graft-versus-host disease (when transplanted cells attack the host cells) and continued with their antiretroviral medications throughout and after the transplant procedures.

Any of these factors could theoretically explain their HIV-free status, but the bone marrow transplantation combined with antiretroviral therapy seems the most likely explanation, said the study authors.

"We believe the transplanted cells killed off and replaced all of the patients' own lymphocytes, including the infected cells, and the donor cells were protected from becoming infected themselves by the antiretroviral therapy they were taking throughout the transplant period," said study senior author Dr. Daniel Kuritzkes, chief of infectious diseases at Brigham and Women's Hospital and professor of medicine at Harvard Medical School in Boston.

Graft-versus-host disease also probably played a role, he said. "The replacement of host cells by donor cells is itself a form of graft-versus-host reaction," Kuritzkes explained.

But the only way to verify that the transplant plus antiretroviral therapy can eradicate HIV is to take the patients off their medication regimens.

That would be the "next logical step," said Kuritzkes, adding that this would require patient consent and adherence to ethics protocols.

But even if the transplant procedure were found to eliminate the reservoir of latent HIV cells, bone marrow transplantation is a very risky procedure. Kuritzkes said he does not "foresee bone marrow transplantation being performed on otherwise healthy HIV-infected patients who are doing well on

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HIV Undetectable in 2 Men After Bone Marrow Transplants: Study

HealthDay – 1 hr 12 mins ago THURSDAY, July 26 (HealthDay News) -- Following bone marrow transplants, two men infected with HIV no longer have any traces of the AIDS-causing virus in their lymphocytes, researchers report.

Lymphocytes are a type of white blood cell and are a key part of the immune system.

The U.S. researchers suspect that bone marrow transplantation along with continuation of antiretroviral therapy resulted in the dramatic effects evident eight months post-transplant. They are scheduled to present these preliminary findings Thursday at the International AIDS Conference in Washington, D.C.

HIV patients on antiretroviral therapy often achieve "undetectable viral loads," meaning there are no virus particles in their blood. But they still have latent HIV in their lymphocytes, and if antiretroviral therapy were discontinued, the latent HIV could reactivate.

But having no traces of HIV in these white blood cells is an indication that this "reservoir" of latent HIV may have been eliminated, the researchers believe.

At this point, they are far from saying these patients are cured. But the findings are "exciting," said Dr. Savita Pahwa, director of the Center for AIDS Research at the University of Miami Miller School of Medicine, who was not involved with the study.

"Every hint you get that it's possible to wipe out the reservoir needs to be investigated," she said.

"Eliminating the reservoir is the key to the cure," said Pahwa. She also stressed that it would only be possible to say these patients were "functionally cured" if the virus did not rebound when the patients went off antiretroviral therapy.

The two men whose cases are described in the paper underwent chemotherapy for blood cancers before receiving stem cell transplants. One had his transplant two years ago; the other, four years ago. Both also developed graft-versus-host disease (when transplanted cells attack the host cells) and continued with their antiretroviral medications throughout and after the transplant procedures.

Any of these factors could theoretically explain their HIV-free status, but the bone marrow transplantation combined with antiretroviral therapy seems the most likely explanation, said the study authors.

"We believe the transplanted cells killed off and replaced all of the patients' own lymphocytes, including the infected cells, and the donor cells were protected from becoming infected themselves by the antiretroviral therapy they were taking throughout the transplant period," said study senior author Dr. Daniel Kuritzkes, chief of infectious diseases at Brigham and Women's Hospital and professor of medicine at Harvard Medical School in Boston.

Graft-versus-host disease also probably played a role, he said. "The replacement of host cells by donor cells is itself a form of graft-versus-host reaction," Kuritzkes explained.

But the only way to verify that the transplant plus antiretroviral therapy can eradicate HIV is to take the patients off their medication regimens.

That would be the "next logical step," said Kuritzkes, adding that this would require patient consent and adherence to ethics protocols.

But even if the transplant procedure were found to eliminate the reservoir of latent HIV cells, bone marrow transplantation is a very risky procedure. Kuritzkes said he does not "foresee bone marrow transplantation being performed on otherwise healthy HIV-infected patients who are doing well on

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HIV Drug May Prevent Bone Marrow Transplant Complication

HealthDay – 1 hr 3 mins ago WEDNESDAY, July 11 (HealthDay News) -- An HIV drug significantly reduced the risk of graft-versus-host disease, an all-too-common complication in blood cancer patients following bone marrow transplants, new research finds.

Bone marrow is the spongy tissue inside the bones that contains immature cells, or stem cells. In an "allogeneic" bone marrow transplantation, also called a stem cell transplant, a patient's own stem cells and immune system are wiped out by chemotherapy and radiation. Then, the patient receives the transplant, or bone marrow, from a closely matched donor.

The treatment is used for several types of blood cancers, including lymphoma and leukemia.

But a common complication of a bone marrow transplant is graft-versus-host disease. It occurs when transplanted immune cells attack patients' healthy tissue, a complication that can be minor or life-threatening.

"Graft-versus-host disease affecting the skin, liver, gut and other organs is a dreaded complication of allogeneic stem cell transplantation either from a related or unrelated donor," said one expert, Dr. Jasmine Zain of NYU Langone Medical Center in New York City. "The rates are 35 percent with related donors and up to 57 percent by day 100, even in reduced-intensity transplants," added Zain, who is director of the Bone Marrow Transplant Program and assistant professor in the division of hematologic malignancies and medical oncology at the center.

The study was conducted by a team at the University of Pennsylvania's Perelman School of Medicine and included 38 patients with several types of blood cancers. The cancers included acute myeloid leukemia, myelodysplastic syndrome, lymphoma and myelofibrosis. All of the patients were given the drugs tacrolimus and methotrexate, which suppress the immune system and are a standard treatment to prevent graft-versus-host disease.

The patients were also given a 33-day course of the HIV drug, maraviroc, beginning two days before their transplant.

None of the patients treated with maraviroc developed graft-versus-host disease in the gut or liver within the first 100 days after their transplant. The liver and gut are the most serious locations for the complication, the researchers noted.

After six months, 6 percent of these transplant patients developed severe graft-versus-host disease compared to 22 percent of a group of similar patients who weren't treated with the HIV drug.

In addition, fewer in the group given the HIV drug developed graft-versus-host disease in their liver or gut compared to those given the standard treatment.

One year following transplant, about 15 percent of patients given the HIV drug developed severe graft-versus-host disease compared to 29 percent of patients who received standard therapy.

The study was published in the July 11 edition of the New England Journal of Medicine.

Researchers explained that the HIV drug redirects these immune cells without having to suppress patients' immune systems. Because their immune systems aren't compromised by the drug, patients should be less vulnerable to infections and to a relapse of their cancer.

"It appears that our new approach allows us to prevent some patients from developing

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HIV Drug May Prevent Bone Marrow Transplant Complication

HealthDay – 1 hr 2 mins ago WEDNESDAY, July 11 (HealthDay News) -- An HIV drug significantly reduced the risk of graft-versus-host disease, an all-too-common complication in blood cancer patients following bone marrow transplants, new research finds.

Bone marrow is the spongy tissue inside the bones that contains immature cells, or stem cells. In an "allogeneic" bone marrow transplantation, also called a stem cell transplant, a patient's own stem cells and immune system are wiped out by chemotherapy and radiation. Then, the patient receives the transplant, or bone marrow, from a closely matched donor.

The treatment is used for several types of blood cancers, including lymphoma and leukemia.

But a common complication of a bone marrow transplant is graft-versus-host disease. It occurs when transplanted immune cells attack patients' healthy tissue, a complication that can be minor or life-threatening.

"Graft-versus-host disease affecting the skin, liver, gut and other organs is a dreaded complication of allogeneic stem cell transplantation either from a related or unrelated donor," said one expert, Dr. Jasmine Zain of NYU Langone Medical Center in New York City. "The rates are 35 percent with related donors and up to 57 percent by day 100, even in reduced-intensity transplants," added Zain, who is director of the Bone Marrow Transplant Program and assistant professor in the division of hematologic malignancies and medical oncology at the center.

The study was conducted by a team at the University of Pennsylvania's Perelman School of Medicine and included 38 patients with several types of blood cancers. The cancers included acute myeloid leukemia, myelodysplastic syndrome, lymphoma and myelofibrosis. All of the patients were given the drugs tacrolimus and methotrexate, which suppress the immune system and are a standard treatment to prevent graft-versus-host disease.

The patients were also given a 33-day course of the HIV drug, maraviroc, beginning two days before their transplant.

None of the patients treated with maraviroc developed graft-versus-host disease in the gut or liver within the first 100 days after their transplant. The liver and gut are the most serious locations for the complication, the researchers noted.

After six months, 6 percent of these transplant patients developed severe graft-versus-host disease compared to 22 percent of a group of similar patients who weren't treated with the HIV drug.

In addition, fewer in the group given the HIV drug developed graft-versus-host disease in their liver or gut compared to those given the standard treatment.

One year following transplant, about 15 percent of patients given the HIV drug developed severe graft-versus-host disease compared to 29 percent of patients who received standard therapy.

The study was published in the July 11 edition of the New England Journal of Medicine.

Researchers explained that the HIV drug redirects these immune cells without having to suppress patients' immune systems. Because their immune systems aren't compromised by the drug, patients should be less vulnerable to infections and to a relapse of their cancer.

"It appears that our new approach allows us to prevent some patients from developing

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Court won't reconsider bone marrow payments ruling

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