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[交流] 【转帖】德国医生宣布“治愈”一例HIV患者已有19人参与

Reuters) - German researchers who used a bone marrow transplant to treat a cancer patient with the AIDS virus, have declared him cured of the virus -- a stunning claim in a field where the word "cure" is barely whispered.

The patient, who had both HIV infection and leukemia, received the bone marrow transplant in 2007 from a donor who had a genetic mutation known to give patients a natural immunity to the virus.

Nearly four years after the transplant, the patient is free of the virus and it does not appear to be hiding anywhere in his body, Thomas Schneider of Berlin Charite hospital and colleagues said.

"Our results strongly suggest that cure of HIV has been achieved in this patient," they wrote in the journal Blood.

AIDS researchers have rejected the approach on any kind of scale for patients with HIV. A bone marrow transplant is a last-ditch treatment for cancers such as leukemia.

It requires destruction of a patient's own bone marrow -- itself a harrowing process -- and then a transplant from a donor who has a near-exact blood and immune system type. Months of recovery are needed while the transplant grows and reconstitutes the patient's immune system.

"It's not practical and it can kill people," said Dr. Robert Gallo of the Institute of Human Virology at the University of Maryland, who helped discover the human immunodeficiency virus that causes AIDS.

"It is possibly a cure, that's for sure, you won't know for absolute sure until the person dies and undergoes extreme PCR (genetic) analysis of post-mortem tissue."

The mutation affects a receptor, a cellular doorway, called CCR5, that the AIDS virus uses to get into the cells it infects.

Since the 1990s scientists have known that some people, mostly of Northern European descent, have the mutation and are rarely infected with HIV.

"They are uninfectable, virtually," Gallo said.

Some researchers are working on the idea of gene therapy to treat or try to cure HIV, but the technology is still in experimental stages.

"I don't want to throw cold water on an interesting thing, but that's what it is -- an interesting thing," Gallo said.

Schneider's team has been following the patient, taking samples from his colon, liver, spinal fluid and brain as he developed various conditions that justified the tests. They tested all these samples for evidence of the virus, which can be difficult to detect unless it is actively infecting cells.

All these places are suspected "reservoirs" where HIV can hide out for years, to rebound in patients who stop taking drugs that suppress the infection.

This patient appears to have a fully functioning immune system, they found, which appears genetically identical to cells from the donor -- not the patient's own immune cells.

Schneider's team found no evidence of HIV anywhere.

"From these results, it is reasonable to conclude that cure of HIV infection has been achieved in this patient," they wrote.

The AIDS virus infects 33 million people globally and has killed more than 25 million since the pandemic began in the 1980s. Cocktails of strong drugs can suppress the virus, keeping patients healthy and reducing the chance they will infect others, but there is no vaccine.
编译：

路透社讯——德国研究者宣称在通过骨髓移植治疗一位感染AIDS病毒的白血病患者的同时，治愈了该患者的病毒感染——此项惊人报道中的“治愈”一词，在该领域几乎只是个传闻。

柏林Charite 医院的Thomas Schneider医生和他的同事们发表在最近一期《血液》杂志中的文章报告了一例合并HIV感染的白血病患者，在2007年接受过骨髓移植后的近4年时间里，不再有病毒感染而且似乎在体内也没有病毒潜伏。骨髓的捐献者携带一种可使患者对HIV病毒具有天然免疫性的基因突变。该研究结果强烈提示HIV的治愈已经在这例患者中实现。

骨髓捐献者携带的这种基因突变可影响一种叫做CCR5的细胞通道受体，AIDS病毒常通过这种通道进入并感染细胞。上世纪90年代起科学家们发现，在某些人群中，主要是北欧系人群携带该突变，很少发生HIV感染。事实上，携带这种基因突变的人不可被HIV感染。已经有研究者们正在设法通过基因疗法来治疗或试图治愈HIV，但这种技术仍处于实验阶段。
Schneider医生的研究小组一直在跟踪随访该患者，并随着疾病的发展从患者的结肠、肝脏、脑脊液和脑组织中进行采样，并检测所有这些样本中是否存在病毒感染的证据。在这样的检测中除非是活性感染的细胞，否则很难被检出。所有这些采样部位都是HIV可疑潜伏之处。HIV病毒可能潜伏数年，并在在患者停止服用抗感染药物后重新开始复制。Schneider医生和他的同事们没有发现任何HIV感染的证据，却发现该患者表现出了健全的免疫系统功能，在遗传上与骨髓捐献者的细胞相似——而非患者自身的免疫细胞。从这些结果来看，有理由得出结论：HIV感染的治愈在这例患者中实现了。

但AIDS研究者们反对将该方法用于任何HIV感染的患者。骨髓移植仅作为白血病这类癌症的最后治疗手段。这种治疗本身就是一个痛苦的过程——需要破坏患者自身的骨髓，然后从一位血型和免疫型几近相同的捐赠者获得骨髓移植。免疫缺陷病毒导致AIDS的发现者之一，美国马里兰大学人类病毒研究所的Robert Gallo博士认为这种方法并不实用而且可能致命。他指出“这有可能是治愈，可以肯定；但并不能完全肯定，除非这个患者死后进行彻底的死后组织PCR（遗传）分析。”

自上世纪80年代AIDS病毒感开始染流行以来，全球共有3300万人感染该病毒，并有超过2500万人死于这种感染。含有强力抗病毒药物的鸡尾酒疗法可抑制病毒复制、保持患者健康并减少传染他人的机会，但至今尚无疫苗。

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