[Cass]

These sort of articles pop up every few months and make people hopeful for a cure, but this is sadly unlikely to ever be a viable one.

Stem cell transplantation is a standard treatment for several blood cancers, but will almost certainly never be a standard HIV treatment for anyone except patients who need a transplantation anyway, for one single reason: with modern medicine, living with transplanted stem cells is significantly worse than living with HIV.

With modern meds, HIV patients can have a normal life expectancy and live basically normal lives.

You know how in traditional organ transplantation, your own immune cells will attack and often destroy the transplanted organ? In stem cell transplantation, your transplanted immune cells will attack every single organ in your body. Look up "graft versus host disease."

After stem cell donation, most patients will have to take immuno-suppressants that a have significantly worse side effects than modern HIV meds do, often for the rest of their lives - and that's the lucky ones, where the meds will successfully treat the graft versus host disease. One of the more gruesome sights I've seen in my medical career was a lady with a severe graft versus host skin reaction that her doctors couldn't get under control despite massive doses of immuno-suppressants. Eventually large parts of her skin peeled off in strips, like something out of a horror movie. Then she died of pneumonia from the immuno-suppressants.

This is an extreme example, of course, and many people live perfectly ordinary lives after stem cell transplantation, but the failure more is both more likely and more gruesome than the one for antiviral HIV treatment.

[maxander]

The avenue towards making this a viable, routine cure for HIV is by performing a “transplant” of the patient’s own immune stem cells that have been genetically modified to carry the anti-HIV genes. That avoids (if done right) the horrific autoimmune challenges you describe, but like everything else it comes with its own technical challenges that are still being worked out. (I think https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935568/ is a good review of the whole idea.) To me (though I’m not an HIV researcher by any means!) this sounds like the most promising shot we have at regularly curing the disease.

[southernplaces7]

>but this is sadly unlikely to ever be a viable one.

I'm not a medical expert by any means, but you claiming this is unlikely to ever be a viable idea makes me think of the sheer number of things we take for granted today in medicine that to a 19th century or even an early 20th century doctor would seem flatly absurd, or completely incredible. A supposition of never makes a bet that one's own limited frame of knowledge, cognitive capacity and imagination has a leg up on all the potential decades ahead of us worth of new discoveries by a vast number of other very clever people. It' s a bet I wouldn't make in my own favor or anyone else's.

[voidpointercast]

This is correct. I have an extremely rare leukemia <1 in 100k, and as said above, the only cure is allogenic marrow transplant. To put it bluntly, survival is at best a 2/3 dice roll - and that's if you're diagnosed before 40.

This is not something you're going to want for something as apparently treatable as HIV.

[ok_dad]

I hope your die falls on one of the 2 good sides.

[Terr_]

Not the same as large-scale transplantation, but that reminds me of some work in Chimeric Antigen Receptor (CAR) T-Cell therapy, where the dangerously-useful cells either have a manual suicide-switch or else another method to temporarily deactivate/reactivate them.

So still sci-fi at this point, but I'm imagining some kind of "bone marrow in a box" implant which cages the borrowed immune-system (copied, rather than genetically-engineered) within a barrier that somehow allows only roaming/non-reproducing cells to exit.

[fzeroracer]

This seems like a little bit of a fearmongering. We're slowly understanding GVHD and GVT issues, suppressing one while keeping the other. The frequency of GVHD has been going down over time as we better match donors to the patient.

There are a lot of treatments that started off just like this. For things we thought we would never have a proper cure for, until we gradually understood how treatment worked and how to refine that treatment.

[Llamamoe]

Don't we just need to induce new stem cells from the patient's own cells, and transplant those in?