An unhelpful cure

According to a recent article from the New York Times,

Doctors in Berlin are reporting that they cured a man of AIDS by giving him transplanted blood stem cells from a person naturally resistant to the virus.

But while the case has novel medical implications, experts say it will be of little immediate use in treating AIDS. Top American researchers called the treatment unthinkable for the millions infected in Africa and impractical even for insured patients in top research hospitals.

“It’s very nice, and it’s not even surprising,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “But it’s just off the table of practicality.”

But while the case has novel medical implications, experts say it will be of little immediate use in treating AIDS. Top American researchers called the treatment unthinkable for the millions infected in Africa and impractical even for insured patients in top research hospitals.

“It’s very nice, and it’s not even surprising,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “But it’s just off the table of practicality.”

The patient, a 42-year-old American resident in Germany, also has leukemia, which justified the high risk of a stem-cell transplant. Such transplants require wiping out a patient’s immune system, including bone marrow, with radiation and drugs; 10 to 30 percent of those getting them die.

Other problems include the difficulty of finding a viable bone marrow match, which is difficult in the best cases, and would be dramatically compounded by the need to find an HIV-resistant donor.  And, of course, there are the tremendous costs incurred by such a procedure.

Then — and I was glad to see that the article brought this up immediately — there’s the issue of accessibility.  This particular situation raises, in my mind, a lot of persistent ethical questions that hover around AIDS research and treatment.  Should promising treatment leads be followed when they would be prohibitively expensive for most or virtually all people living with HIV/AIDS?  Where should that line be drawn?  Can it be drawn?

These are hard questions that I’ve thought about a lot, and will probably keep mulling over for a long time.  I’d love to hear some readers’ thoughts…

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~ by h.e.g. on November 20, 2008.

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