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HIV and bone marrow question
Jul 25, 2011

Greetings,

So I read of the gentleman in europe that recieved a functional HIV cure with a bone marrow transplant that was done to address other issues he had.

I've also seen folks stating this isn't a viable option due to the risk involved in completely ablating a persons immune system. I had a friend who's child didn't survive a bone marrow proceedure, so got that.

What I'm missing is why in the case of HIV, could a marrow transplant be done in which only SOME of the marrow cells are replaced with those expressing or engineered to provide the desired quality? I get it for cancer where the cells themselves are part of the problem, but, in the case of HIV, it seems the HIV is there anyway, and adding resistant immune elements at any scale would provide benefit.

Thanks,

Steve

Response from Dr. McGowan

Thanks for your question Steve.

In order for HIV to be able to enter and infect a cell it must bind to 2 receptors on the cell surface...one of them is CD4 (which is found on certain types of T cells called Helper cells as well as some other types of white blood cells) and a second receptor (either one called CCR5 or another called CXCR4). Most HIV binds to CD4 and CCR5 and about half the time can use the other co-receptor.

Some people are naturally born without any CCR5 receptors on their T cells. This is especially true in some Northern European countries where lacking CCR5 on cells mnay have protected people centuries ago from certain plagues that killed off vulnerable people.

What they did in this case is found a bone marrow donor who not only was a match genetically for the patient, but who also lacked CCR5 on their CD4 cells. By replacing the patient's bone marrow with one that cannot produce T cells that have CCR5 on their surface coat meant that HIV had no way of getting inside his T cells. With only 1 of the 2 receptors present the virus had no way to enter the cells.

Hope that helps explain it.

Joe



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