{"id":2840,"date":"2012-06-13T16:55:24","date_gmt":"2012-06-13T20:55:24","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=2840"},"modified":"2015-06-04T15:14:31","modified_gmt":"2015-06-04T19:14:31","slug":"questions-about-hiv-cure-and-a-very-funny-quote","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/questions-about-hiv-cure-and-a-very-funny-quote\/2012\/06\/13\/","title":{"rendered":"Questions About HIV Cure, and a Very Funny Quote"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/06\/4974319_blog1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-2841\" title=\"pink elephant\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/06\/4974319_blog1.jpg\" alt=\"\" width=\"280\" height=\"229\" \/><\/a>The <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa0802905\" target=\"_blank\">single case of HIV cure<\/a> following allogeneic bone marrow transplant is in the news again, this time because of data just presented at &#8220;The\u00a0International Workshop on HIV and Hepatitis Virus Drug Resistance and Curative Strategies&#8221; (formerly known as the &#8220;HIV Resistance Workshop&#8221; &#8212; how&#8217;s that for rebranding?).<\/p>\n<p>I&#8217;m not at the meeting, which is too bad since they often have it in <a href=\"https:\/\/www.google.com\/search?q=sitges&amp;hl=en&amp;prmd=imvns&amp;source=lnms&amp;tbm=isch&amp;ei=Af7YT8CKOuWg6QGi6YG6Aw&amp;sa=X&amp;oi=mode_link&amp;ct=mode&amp;cd=2&amp;ved=0CGgQ_AUoAQ&amp;biw=1350&amp;bih=678\" target=\"_blank\">splendid locations<\/a>.<\/p>\n<p>But from what I gather based on the report, here are the key findings in the study:<\/p>\n<ul>\n<li>The patient remains off antiretroviral therapy, with a normal CD4 cell count<\/li>\n<li>He has generously submitted multiple specimens for research analyses at multiple different time points<\/li>\n<li>Highly sensitive assays of various sorts have been performed at several labs<\/li>\n<li>HIV RNA\u00a0has been detected in plasma in\u00a02 (of 4) labs from 3 different time points; levels are lower than those typically seen in virologically suppressed patients on ART<\/li>\n<li>HIV DNA was detected in a rectal biopsy sample by one lab<\/li>\n<li>No HIV has been detected in CSF or peripheral blood mononuclear cells<\/li>\n<li>No replication-competent HIV has been isolated<\/li>\n<\/ul>\n<div>A more detailed summary of the presentation is over here at <a href=\"http:\/\/www.natap.org\/2012\/HIV\/061212_04.htm\" target=\"_blank\">NATAP<\/a>, and some of the controversy it has sparked is summarized at <em><a href=\"http:\/\/news.sciencemag.org\/scienceinsider\/2012\/06\/evidence-that-man-cured-of-hiv.html\" target=\"_blank\">Science<\/a>\u00a0<\/em>and, um,\u00a0<em><a href=\"http:\/\/www.poz.com\/articles\/hiv_berlin_patient_761_22535.shtml\" target=\"_blank\">POZ<\/a>.<\/em><\/div>\n<p>My gut feeling is that the findings are potentially real, but unlikely to be of much clinical significance if virus can only be detected intermittently by special assays, especially since he&#8217;s been off all HIV treatment for more than 5 years.<\/p>\n<p>But they may <em>not<\/em> be real &#8212; we need to remember that a false positive test result is more likely when the test&#8217;s sensitivity is cranked up and it&#8217;s performed multiple times.<\/p>\n<p>Or as more colorfully put by Doug Richman:<\/p>\n<blockquote><p>If you do enough cycles of PCR, you can get a signal in water for pink elephants.<\/p><\/blockquote>\n<p>And if this interesting presentation tells us anything, it&#8217;s that defining success in <em>any<\/em> study of an HIV cure strategy is going to be very, very difficult.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The single case of HIV cure following allogeneic bone marrow transplant is in the news again, this time because of data just presented at &#8220;The\u00a0International Workshop on HIV and Hepatitis Virus Drug Resistance and Curative Strategies&#8221; (formerly known as the &#8220;HIV Resistance Workshop&#8221; &#8212; how&#8217;s that for rebranding?). I&#8217;m not at the meeting, which is [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5,10],"tags":[111,258,423,703],"class_list":["post-2840","post","type-post","status-publish","format-standard","hentry","category-hiv","category-infectious-diseases","category-research","tag-berlin-patient","tag-cure","tag-hiv","tag-pcr"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2840","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=2840"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2840\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=2840"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=2840"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=2840"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}