I suspect that the mortality rate would be much lower amongst patients being treated for HIV. Bone marrow transplants as a therapy for leukemia requires killing the existing cells with radiation. This is completely sensible -- you've got some cancerous cells, so nuke everything and start over from the beginning.

Confounding the mortality stats is the fact that individuals undergoing treatment are very sick from the start. We might see better survival rates amongst comparatively healthy people.

In this case, you don't necessarily need a clean slate. "All" you need is a population of cells generating HIV resistant T-cells. AIDS manifests in individuals with extremely low T-cell counts. If a population of CD4 mutants could take hold within a larger population, it might be enough to prevent AIDS and bring viral titers low enough to eliminate transmission.

Nevertheless, I agree -- it's hardly practical, but it may be a beachhead.

I read an article back a few years, about how when they do a normal organ transplant (like a kidney) the patient benefits enormously from also getting a bone marrow transplant from the same donor. For a transplant you shut down the immune system completely, and keep it in a subdued state forever afterwards. With the matching bone marrow they could re-start the immune system to a mixed state afterwards, that accepted the original organs and the donation.

Anybody remember that article? I'd like to find it again.

I think most AIDS patients would gladly take that 10% chance.

AIDS has actually become manageable, and most HIV+ patients in the developed world die of other causes (cancer, aging, etc.) instead of AIDS. So I wouldn't be too sure.

And now HIV patients have a choice between manageable and treatable. For most of us, I think the choice would probably be obvious.

That depends on what exactly manageable means and what the risks of the cure are. The choice seems by no means obvious to me.

Here is a hypothetical example (because I don’t know much about HIV): Getting rid of frequent headaches (the hypothetical side-effect of managing a hypothetical otherwise deadly disease) with a cure that has a 1:5 chance of death doesn’t seem like a good deal to me.

You're right. The article implies no side effects other than the strict (even aggressive, if you will) treatment regiment, which does seem somewhat fishy.

HIV may not be a death sentence anymore, but it's still a serious disease with profound implications in one's lifestyle, and as far as I'm concerned, a cure can't come soon enough.

No, patients do not have this choice because no licensed physician would give them said choice. People here are talking as if BMT were this mundane thing that you can just decide you want to do some afternoon.

I'm not really sure what's the point you're trying to make. Bone marrow transplants are not some unproven treatment. Stem cell research generally seems troubling to some politicians; this specific application is probably not approved but I don't see any reason why it shouldn't be in the near future.

The mortality of the treatment that you and I are talking about is far higher than the mortality of the disease. Orders of magnitude higher.

Presumably that risk could be mitigated with improved processes (vacuum room?). If I read correctly, this was extreme application of an existing technique (chemotherapy).

Admittedly this is pretty intense, but so are treatments for cancer. Let's hope this leads to improved and safer treatments in the future.

It's a bone marrow transplant. The process is rather well established. http://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transpl...