美国医生用骨髓移植清除两名艾滋病患者体内HIV病毒

哈佛大学附属的布里格姆妇女医院的研究人员imothy Henrich在国际艾滋病会议上称，美国2位艾滋病呈阳性的男性患者接受骨髓移植后停止抗逆转录药物治疗，却没有在体内检测出HIV病毒。这一迹象并未说明HIV患者已被治愈，而令人振奋的是，接受药物治疗后的数月内HIV病毒并没有在血液中反弹式增长。

布里格姆妇女医院的Henrich 和Daniel Kuritzkes研究人员称：“这2位血癌患者接受骨髓移植手术的8个月后（期间一直服用抗HIV药物）在其血液样本中没有发现HIV病毒。”

Henrich在马来西亚举办的国际艾滋病会议上称：“接受治疗的2位男性患者已停止服用抗逆转录病毒药物，1位在15周前，另一位在7周前，结果发现他们两者体内没有HIV病毒。医疗人员对这2位艾滋病患者的治疗效果很好，而他们是否完全被治愈还需一段时间来断定。”

他补充道，HIV病毒可能隐藏在诸如肝脏、脾脏或脑等其它器官中，有可能数月之后重新增长。至少对他们的细胞、血浆和组织进行检测1年，才能确定细胞移植对HIV抗性的全面影响。

Kuritzkes 称，接受治疗的2位患者如果出现HIV病毒反弹式增长将再次接受药物治疗，而这一假设的增长将表明其它器官是HIV病毒的重要栖息地，并在以后的治疗方案中要将这些器官考虑在内。

约翰霍普金斯大学医学院移植专家Christine Durand说：“如果2名波士顿患者得到了治愈，那么一定是抗逆转录病毒治疗，而非基因治疗保护了这些供体细胞。”

艾滋病研究基金会的执行总裁Kevin Robert Frost称：“这项研究提供的信息改变了我们目前对HIV病毒和基因治疗的看法。尽管骨髓移植大规模治疗艾滋病患者是不可行的，但是这有助于为最终战胜HIV病毒提供新方法。”

骨髓移植手术首次治愈艾滋病

据报道，美国人蒂莫西•布朗是经骨髓移植手术治愈的首个艾滋病患者。2007年他在德国接受骨髓移植手术，庆幸的是，骨髓捐献者携带了天然抵御HIV病毒的变异基因CCR5，移植的骨髓细胞不断生成CCR5突变的造血干细胞，其再分化各类具有生理功能的淋巴细胞，最终布朗体内具有了HIV无处藏匿的抵御系统。

布朗的主治医生胡特称：“当时布朗的状态非常不好，病情正在恶化，几乎已经到了死亡的边缘。我便决定进行骨髓移植先治白血病，真的不敢相信，治愈艾滋病的新方法竟然是这样开始的。我本以为布朗做完骨髓移植手术会离开这个世界，真的没有想到，他竟然奇迹般地活了下来，还成为世界第一个被治愈的艾滋病病人。现在，他体内已经没有艾滋病病毒了，已经不再吃药。”

不过也有专家表示，像布朗这样的例子很难复制，他的痊愈包括许多因素，比如布朗体内可能存在的某些基因变异正好配合了骨髓干细胞移植疗法，并发挥了抵抗病毒的积极作用。总体看，攻克艾滋病仍然有很长的路要走。

今年早些时候，美国医生还宣布“功能性治愈”一名因母婴传播而携带艾滋病病毒的两岁女童。这名女童自出生起便开始接受抗逆转录病毒药物治疗，据报道目前其体内艾滋病病毒已被抑制。





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Hematopoietic cell transplantation with cord blood for cure of HIV infections.


Hematopoietic cell transplantation (HCT) using CCR5-Δ32/Δ32 stem cells from an adult donor has resulted in the only known cure of human immunodeficiency virus (HIV) infection. However, it is not feasible to repeat this procedure except rarely because of the low incidence of the CCR5-Δ32 allele, the availability of only a small number of potential donors for most patients, and the need for a very close human leukocyte antigen (HLA) match between adult donors and recipients. In contrast, cord blood (CB) transplantations require significantly less stringent HLA matching. Therefore, our hypothesis is that cure of HIV infections by HCT can be accomplished much more readily using umbilical CB stem cells obtained from a modestly sized inventory of cryopreserved CCR5-Δ32/Δ32 CB units. To test this hypothesis, we developed a screening program for CB units and are developing an inventory of CCR5-Δ32/Δ32 cryopreserved units available for HCT. Three hundred such units are projected to provide for white pediatric patients a 73.6% probability of finding an adequately HLA matched unit with a cell dose of ≥2.5 × 10(7) total nucleated cells (TNCs)/kg and a 27.9% probability for white adults. With a cell dose of ≥1 × 10(7) TNCs/kg, the corresponding projected probabilities are 85.6% and 82.1%. The projected probabilities are lower for ethnic minorities. Impetus for using CB HCT was provided by a transplantation of an adult with acute myelogenous leukemia who was not HIV infected. The HCT was performed with a CCR5-Δ32/Δ32 CB unit, and posttransplantation in vitro studies indicated that the patient's peripheral blood mononuclear cells were resistant to HIV infection.


Hematopoietic stem cell transplantation in HIV-1-infected individuals: clinical challenges and the potential for viral eradication.

Advances in stem cell transplantation and the success of antiretroviral therapy (ART) have made it possible to extend curative cancer therapy to HIV-1-infected individuals with aggressive lymphoma and leukemia. Outcomes of autologous hematopoietic stem cell transplantation in HIV-1-infected individuals are similar to the general population. In allogeneic hematopoietic stem cell transplantation (alloHSCT), there are a growing number of successful case reports and the first national trial is ongoing. Infectious complications do not appear to be increased in patients on effective ART; however, drug interactions and drug interruptions are common. There is also renewed interest in the possibility that alloHSCT could lead to HIV-1 cure.



来源：生物探索