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http://sanfrancisco.cbslocal.com/2011/05/16/apparent-immunity-gene-cures-bay-area-man-of-aids/ (http://sanfrancisco.cbslocal.com/2011/05/16/apparent-immunity-gene-cures-bay-area-man-of-aids/)

They had discovered an "Immunity Gene", people with a particular mutation didn't get AIDS, HIV would start the infection cycle, they'd test positive for a few months, and then it would just go away.  This guy had AIDS since 1995, got a bone marrow stem cell transplant from an immune donor, and now he doesn't have any HIV in his system.  No symptoms of AIDS even though he quit taking the medications when he got the transplant.

--Dave

Even though I would really like for there to be a cure, I cannot mentally accept the possibility...this year - it's been far too crazy so far to add this to the pile.

Yowza.

I read the article, and got a surge of good feelings.

Then I read the comments and promptly  :ye_gods:

We can finally start fucking like its 60s again?

Science, Fuck Yeah!

Aren't bone marrow transplants themselves very risky? Like a last resort kind of thing?

Yeah.  On the other hand, the maintenance treatment for AIDS is not a picnic, and it doesn't work for everyone. 

There's also the little problem of finding donors that are both immune to AIDS and compatible with the patient.  I suspect that much like "Golden Blood" herpes antibody donors, there's going to be a lot of money in it for people with the immunity and a willingness to get huge needles jammed in their hips.

--Dave

I suspect the 'fix' will be doing something like an autologous stem cel transplant (http://en.wikipedia.org/wiki/Autologous_stem_cell_transplantation) and tinkering with the genetics of the patient's own bone marrow that way.

We will live long enough as a species for AIDS to cure itself was a good bet  :drill:

They're getting less and less risky as the technique is getting refined.  For many people with HIV it would be a last resort, so it is a reasonable treatment plan.  Unfortunately, testing for and finding willing donors is going to be tough and there are a LOT of people with HIV worldwide.  I doubt this is going to be the silver bullet.  However it might lead to the silver bullet, if they are able to determine what it is that makes these people immune (CCR5 mutation, IIRC) and then put it to use in another way besides bone marrow transplants.

Great news.  This affects too many of my friends.  I hope this leads to good things.
Yes.  He also had leukemia.  It won't be the answer for everyone, but if a method is found that works, then it can be refined and alternatives can be explored more easily.

Can't stem cells be cultured?

Yay, another miracle cure for rich fuckers.

Having done my research fellowship on a pediatric bone marrow transplant (BMT) ward, I can say that this is a start and not the answer.  So many things can and do go wrong when you completely ablate someone's WBC counts.  It's nothing that will be used routinely and certainly will do little to help the HIV epidemic in 3rd world countries.


While this research is a step in the right direction, this comment is pretty much spot on.  I doubt that Magic Johnson will try this anytime soon though.  Too many risks. 

As it stands, this is only an anecdote, we are still a long way from a cure sadly.

Yeah a marrow transplant isn't exactly a corner street cure.

I guess this will be a politics thread soon.   :heartbreak:

That certainly wasn't my intention.  I mean, Yay and all, but it's not the shot in the arm we're looking for yet.

But hey, we cured Leprosy.  We cured leprosy for fucks sake.  LEPROSY.

I'm with the "Yay, we seem to have solid confirmation that there's a path that shit-cans HIV" crowd, rather than the "Bone Marrow Transplants for Everyone!" crowd.

Although I do kinda want to know if I have that particular mutation myself.....

Anyways, I'm sure if they manage to replicate this elsewhere or figure out the exact interactions, that a lot of money will flow towards drugs that will exploit that particular issue (a new treatment that's probably not an anti-viral) and probably another big push on gene therapy, now that they have a target.

Between that and the new flu shots in development (that seem to target a specific, difficult-to-impossible to mutate part of the virus that is shared between ALL strains of flu, including bird flu) medical science is looking up a bit. Now I only have to be terrified of super-bacteria.

Yeah, but this really is a big fucking deal, if true.  It shows us what makes these people immune and hopefully we can come up with a cheaper way to treat the remaining folks.

The outcome is exactly what you'd expect.  While that's a wonderful thing as far as progress is concerned, getting an outcome that you expect isn't all that interesting scientifically.  

Is it?  I don't know a lot about the progress of HIV research.  I wasn't aware that they would have expected this to work.  

Edit:  I also understand in the world of medicine that you don't do new things unless they are expected to have a fair chance to work.  But HIV is a different cat. 

IIRC, the general process was this:

1) They (HIV researchers) were aware that a specific genetic marker seemed to confer some serious resistance, if not outright immunity, to HIV. There wasn't a whole lot of ethical ways to study it, they just had some statistics that indicated this tiny group wasn't getting AIDS like they were (statistically) supposed to.
2) So some HIV researchers were studying it.
3) A guy with HIV got leukemia.
4) When he was undergoing treatment, someone said "Hey, it's a long shot, but if we've got a choice between matches and one of them has that marker, let's pick that one and see what happens. As long as it's as good a match as the others, there's no harm done to his cancer treatment and it'll do nothing, at worse, to his HIV status"
5) They probably had to go through a lot of HIV patients with leukemia before they got to a guy who had a good match to someone with the marker.
6) They gave the guy that bone marrow and sat back to see what his white blood cells would do, and incidentally cured (or at least dealt a savage blow) to his lethal cancer.
7) Apparently, his new white blood cells made from his new bone marrow ate the HIV virus and laughed at it.

So really, there's not a lot of ethical line-dancing here. It was more "the guy needed new marrow and we picked the good match that had the resistance-marker on it".

I understand the process behind what happened.  They were talking about the CCR5 mutation when I was in medical school.  I simply wasn't aware that this was a slam dunk guaranteed result like Nebu said.  Maybe it was.  I figured he would know better than me since he's in research.

Ok, there's no such thing as a guarantee in medicine.  I apologize for overstating that.  This was an experiment that should have worked given all prior work. 

My point was more that a) this is a good advancement but b) the more interesting result would have been failure of this method.

My apologies for not being clearer.

No problem.  I wasn't trying to yank your chain on this.  I honestly didn't know how much the results were expected. 

I think I should stick to chemistry.  I'm much better at the molecular level than I am with all of this immunology and stem cell stuff anyway. 

I'm perfectly comfortable taking my AIDS/HIV course every three years as required by the Texas State Dental Board.   :why_so_serious:

We had an HIV rotation in med school and it was pretty awful.  It was much more boring than one might imagine. 

It's certainly made the tatoo and piercing industries a hell of a lot more safe, though. I was frankly very impressed by the precautions a local piercer took when a friend of mine got one.

The place was a grubby looking little tatoo shop, but the piercing area was chosen and furnished entirely to be easily sterilized, the guy didn't cut corners, and was very safety concerned -- not just with possible contamination, but with recovery and health of my friend -- including a lengthy discussion of whether or not my friend had a silver allergy or was just prone to infections (he thought the latter, but she went with titanium anyways).

A far cry from piercing guns or your friends with a needle and a bottle of rubbing alcohol. :)

The one area that HIV has probably saved the most people is in the co-prevention of Hepatitis B/C for just the reasons you mentioned, Morat.  Universal precautions are a great thing.  Fuck man, in my dad's dental practice back in the '80s they didn't even use gloves.  They didn't sterilize anything.  Holy shit that is disgusting.

No reason to belittle yourself. Nobody is going to put you under a microscope here.

IIRC, dentists and dental technicians were known for frequently having cold sore breakouts on their fingers. It takes a lot of work to get cold sores on your hands, but ungloved and poking around a mouth is probably the best way to go about, if you do it day in and day out.

Still, what's ironic/sad is you can STILL massively cut hospital infections by posting stuff like handwashing instructions everywhere -- not for visitors, for staff because they either miss, forget, or just skip sanitizing steps. (Probably because they think "Hell, I've got gloves on" and don't really pay too much attention unless there's going to be blood or sharps around)

You know what one of the biggest sources of infection in hospitals is?  Cellphones, particularly the ones the floor nurses carry around with them.  You hit on another great point-  until we can get our hospitals cleaner we're really pissing up a rope with nosocomial infections. 

Odds of it being a single point mutation are next to nil I'd say. I'll wait on seeing the actual paper about this before I get too excited. The press has a grave tendency to overhype the notion of "gene for X", "mutation that stops Y", when in reality the explanations are a lot more involved.


Eradicating smallpox remains one of science's greatest triumphs, and we're almost there with polio.

IIRC, the gene is found in about 1% of Caucasians. I think it's actually a bit bad, insofar as it causes your t-cells or something to be weaker in general, but seems to offer resistance to bubonic plague and smallpox.

Hence why it's floating around in European descendents.

According to wikipedia, they're already testing gene-therapies built on this. Started in 2009.

Infection control is a curious business, it ends up being the least obvious stuff that is often the problem. I don't know about the US, but in the UK doctors no longer wear ties or watches (how often do you wash ties compared to how often you touch them). I'm not sure about mobile phones, but I do know there were a slew of papers a few years back where some curious chaps went and swabbed pretty much everything they could reach on a bunch of wards and came back with some pretty scary results.

I've spent a lot of time in hospitals, operating rooms and emergency rooms.  One important thing that I learned from all this is that a hospital is not a healthy place to be.  The infection control is just a part of the equation.

Here's the paper for those who are interested. (http://bloodjournal.hematologylibrary.org/content/117/10/2791.full.pdf) (might be paywall, I'm accessing this from work).

It's an interesting case, but as a single data point it remains pretty anecdotal. given the complexity of the immune system I'll maintain my view that this guy got lucky in more senses than just getting the transplant until we get to see some more results. Sadly there's no fucking way this is going to help anything in sub-saharan Africa where AIDS is the biggest problem.


No doubt, but it's reassuring to think that the hospital you're going into probably won't end up giving you a dose of C.diff or MRSA or VRE or something equally lovely  :grin:

It's like they took a lot of sick people and shoved them all into the same place...:P

There's an infamous study that got shit-canned by the FDA (for what, IIRC, was understandable rules about patient confidentiality and protection that led to a ridiculous result) where a hospital posted a bunch of reminders and checklists and watched their infection rates plummet.

Then the project got yoinked and the study cancelled because, well, the hospital was using all the patients as guinea pigs for a study without consent. (I *think* that was the issue. The FDA or whomever oversees that sort of thing had rules that basically said "Thou Shalt Not Experiment on Patients without Informed Consent" and, well, the hospital hadn't thought to bother for a study that was aimed at making doctors, nurses, and orderlies wash their damn hands).

Who would have thought, right?   :why_so_serious:

I'm not surprised that the FDA would ding something like that.  Research rules are extremely important but can be confining at times.

I'm not sure if that was the actual rationale used, but there was a big stink about it because the hospital had seen a giant drop in oppurtunistic infections and spread of those really nasty super-bugs, and had to call it off entirely and go back to the status quo.

People immediately started developing FDA-compliant setups for it, of course.

It's just one of those cases where a really good and important rule runs into a bad outcome.

There had to be something else involved with it.  Even as a pilot study that they had to call off because of ethical concerns they should have had some good data to put into a publication.  I believe that there are other studies out now that point to poor infection control as the root cause of the increase in nasty nosocomial infections, but I can't remember where I've seen them and am too lazy to look them up. 

I've turned your process into an episode of House:

1) A guy with HIV gets leukemia.
2) House sends his team to the patient's workplace/home/gym/secret basement where he tortures kittens - and Taub finds a container with paint-thinner at the location. Ahh, of course. Paint thinner. That explains everything.
3) House tells Chase to inject him with .... growth hormones and asparagus-seeds to <something or other that will make it easier/more fun to treat>. Foreman objects to the injection-strategy for 5 seconds then agrees and joins in on the fun.
4) Patient has a near-death experience, but is saved just in time by 13 and Chase, who happen to be strolling past the room where he lies just as the alarm goes off
5) Cuddy is angry with House
6) The team is stuck, so we diverge to a scene with House and Wilson arm-wrestling over whether or not <random fact> is true or false. House cheats and wins.
7) House pops some Vicodin before heading out of the hospital to go home on his bike. Just before he drives off, a ball bounces off a garbage bin right outside the hospital and into the front of a car, which swerves and hits a bus - 5 passengers are brought into the hospital on stretchers. He drives off anyway.
8) 13 discovers, through luck and social engineering, that one of the new patients is immune to HIV.
9) The team collectively calls House to inform him, but says Cuddy refuses to let them to do a bone-marrow transplant because it's too risky to the new patient, who suffers from a broken appendix or some such.
10) House tells them to steal some bone-marrow from him under the rouse of checking him for scuff-marks/some other made-up excuse. Foreman objects, for about 5 seconds, then agrees and goes to do it along with Taub.
11) They eventually get around to doing the bone-marrow transplant, and then sit back to see what his white blood cells will do
12) Cuddy is angry with House
11) Guy is cured of HIV
12) Guy dies from leukemia not long after, but House is happy because he cured him of HIV. Celebrates by spending money on a hooker to wash his bike.

I LOLed.

I can't remember the specifics of it. Maybe it was because they'd developed an actual protocol? They had a very specific and regimented approach, and it sounded for all the world like a company adopting a new safety program.

You know, where suddenly there's tons of signs, training classes, and new procedures?

It could have been the problem was adopting operating procedures for the hospital that hadn't been cleared, which is an understandable rule.

After a year of Clinicals at two of the area's largest hospitals I can say it's not handwashing or lack of it that's the big problem, at least anymore. every room has a no-touch purrel dispenser at the door and and gloves. The routine is purrel on the way in, glove up, do whatever, deglove, wash hands, purrel on the way out. Next room starts the process over again. The problem is housekeeping. The housekeeping staff in both places was almost universally shitty and bad at cleaning. using the same rag to wipe stuff for the whole floor, poor wiping, etc. Rooms used for isolation would change almost daily based on admittance and discharges and the housekeeping staff could barely be bothered to come clean the room a second time in one day, let alone properly sterilize the beds, table, and nightstands. So the bed that a stroke victim with c. diff shit all over ever couple hours for a week gets a half hearted couple of swipes with a semi-damp rag after a quick spray of disinfectant, then a new cover. There were a couple times where a new patient had been admitted into a bed that hadn't even had the linen changed yet. Luckily as students we had the time and focus to catch stuff like that, but if we hadn't been there the nursing staff is always stretched way too thin to know.


Also, Hospital floors. Holy fucking god do they everything that you don't want on you covering them. Never, ever set anything you want to ever touch again down on the floor of a hospital. In any part of the hospital. Hands get washed a jillion times a day. The bottom of shoes? Not once.

Yeah staff in hospitals in the UK now regularly disinfect their hands. Medical students in fact get told off for not doing this obviously enough (if the patient doesn't know you've disinfected your hands it's treated as pretty much the same as you not doing it at all). A student nurse I know got a bad comment on her performance thing because she washed her hands with soap rather than using the disinfectant (which apparently dried her skin pretty bad and led to lots of flaking/cracking) since she couldn't do that so obviously in front of patients. Of course like bob said the problem is that this stuff gets shoved in everyone's faces (and it is a good thing they're doing it) but then floors don't get properly cleaned as often as they would need to be, cleaners don't properly disinfect stuff and nurses have so much more shit to deal with now that there's no way they're going to be devoting serious time to making sure the cleaning staff are doing their jobs to the ridiculously high standard they need to.

Cleaning things to a really aseptic standard is labor-intensive and takes both special training and the time to do it right.  Hospitals don't bother outside the operating rooms, they generally just contract it out to the lowest bidder.  If they paid for both the quantity and quality of work it would take, probably 3/4 of the infections would go away.

When you consider the amount charged these days for just a bed, the fact that they aren't should be a scandal in and of itself.  And it does seem to have gotten worse, I remember going to hospitals in the 80's and there always being the smell of Lysol everywhere.  You don't smell that anymore, and I don't think it's because they use odorless disinfectants.

--Dave

This wouldn't fix the real problem which is MRSA, et al.  They would have to eliminate almost all nosocomial infections to be effective.  Even if 1% of the bacteria live, that is an infective source and, if they have been selected out as resistant by killing off all the non-resistant bacteria you are in essence compounding the problem.  At this stage they need to figure out a way to be 100% effective which probably isn't going to happen. 

We could go back to spraying aerosolized phenol everywhere like they did at the turn of the 20th century!  :why_so_serious:

Purel is shit for killing most things.  So is soap unless you're VERY thorough (triclosan as an additive is about worthless).  Iodine and bleach are necessary for killing really infectious agents and most custodial workers will bitch profusely about being in prolonged contact with either.   

I suspect they will have to go to something akin to a "disposable" room, or something they could completely immerse in a bleach solution to be completely effective.  Another option would be to have much of the current "in house" treatment done actually in home settings, that way there is less contamination actually passed from one person to the next.  Obviously this would only work with more mild illnesses that didn't need a SICU/MICU situation. 

Autoclave the room. :)

Seriously, build a giant autoclave. Make all the furniture steel. Remove the linens/covers/mattresses to sterilize elsewhere and just bake the damn room. If you design the room to make everything either stainless steel or designed to be removed and easily sterilized elsewhere, you can probably get it done for only a small fortune. :)

When I was on home care that was one thing the nurse mentioned.  It's not that my home is going to be more sterile than a hospital, because it's certainly not, however all the germs there I am already adapted to.  My chance of an infection actually decreases.

So can i start raw dogging crack whores yet or not?

That depends. Do you have leukaemia?

And your chances of getting an infection with something really nasty decreases a lot.  MRSA/VRE are going to be much less likely in this scenario, even though some people still carry those bugs as asymptomatic carriers.

I don't know about enterococci, but carriage rates for Staph are pretty high.


In all likelihood this wouldn't reduce rates significantly. While it is important for surfaces and furniture to be clean, bacteria don't thrive very well on those. The major issues are things which get touched with high frequency (and hands of course). So phones, taps, lines, handles, monitoring equipment etc are the real problem. The issue is that a lot of these things aren't the easiest objects to clean regularly.

The UK Design Council (http://www.designcouncil.org.uk/our-work/challenges/Health/Design-Bugs-Out/Case-studies-equipment/) actually tackled this problem and came up with a bunch of clever solutions.

That's why I'm thinking almost everything is going to have to be disposable. They may have to develop cheap interface units for some of the monitoring equipment or have a more centralized unit with disposable in-room monitoring probes/guages, etc.  Of course this is going to create a lot of waste...

Yes.


Report back.




No.

Massive bug-bombs filled with quickly decaying nerve gas and totally sealed environments......

*grin*. Expose the room to total vaccuum! Run everything through a transporter! Reverse the polarity!

Ludicrous speed........? :grin:

Bacteria and viruses die when accelerated into plaid.

Build the hospital out of brass.

Autoclave the patients upon entry. If no bacteria can get in, you don't need to sanitize!

Better yet kill then and raise them as the undead, who will feast upon the living bacteria and viruses to grow stronger and healthier.

Or we can take a page from introducing 'useful wildlife' into new ecosystems. Let's find a really predatory bacteria or virus that eats others of it's kind and flood hospitals with that! It'll work out great, just like rabbits and goats.

Great... a biological skynet.  :why_so_serious:

(http://content.answcdn.com/main/content/img/McGrawHill/Encyclopedia/images/CE069900FG0010.gif)
Bitches don't know bout my T4.

(http://upload.wikimedia.org/wikipedia/commons/thumb/5/56/Tevenphage.svg/800px-Tevenphage.svg.png)

Something like this is almost enough to make me believe in Intelligent Design (or alternatively, Alien Panspermia).  That thing just does not *look* "organic" or naturally evolved.

--Dave

I don't think it necessitates making everything disposable as having parts that can be detachable and easily cleaned, so having monitors and whatnot that can be detached and replaced easily with the original being sent off for cleaning. I imagine that part of the design brief for a lot of this stuff involves minimising waste and providing it's designed to be easily sterilised that shouldn't be too much of a drawback.

Hospitals are already going to a lot of disposable stuff for several reasons.  First, there is a significant cost involved with cleaning/sterilization because you have to pay for man hours to do this stuff.  Staff overhead is usually very high with medical facilities anyway.  It is often cheaper and easier to just buy throw away supplies.  Second, there is much less chance of having a breakdown in the sterilization/cleaning chain leading to unwanted contamination.  Third, regulations involved with sterilization procedures can be a pain, therefore you can possibly cut a lot of red tape by going disposable.

And wood (also naturally antiseptic). Steampunk hospitals ahoy!

(http://4.bp.blogspot.com/_4OYGjUrdllo/SaA0DSU0sdI/AAAAAAAARIs/AcgU8EdAXLc/s400/Steampunk_Abe_Lincoln_2008.jpg)

Uh, isn't that an artists rendition?

NVM, Freeky.

I'm still pissed about a proposal I did on using disposable leads for cardiac monitoring.  I showed how much a hospital infection costs, how often you can get it and from what equipment (1st was IV pumps, 2nd was cardiac monitor cables), but they shot it down.  Well I should say our old CNO shot it down, since it would be a big item purchases and for some reason it can't be charged to the patient.  Made no sense, as we have disposable items now that are charged, plus the main thing would be that the ER Doctor or Admitting Doctor wrote for a cardiac/telemetry order we would be justified in charging for that supply.  Then again HCA may think of how things are done down in Tennessee or the South, instead of how us yankies play.

Oh K9, thanks for the link, those pulse ox's & bp cuffs look great!  It is a pain in the ass to clean all of the equipment.  I was going around taking pictures of dirty equipment and then cleaning it.  I know some of the issue is that housekeeping won't even touch the electrical equipment because they don't want to be blamed for equipment breaking down.  Bleach is awesome but it tears equipment up, and to kill everything, it is usually a process of 1. wipe down visible stuff, 2. spray with Dispatch (bad mofo bleach cleaner, it kills shit dead, if given enough time), 3. let set for 2 minutes, 4. wipe with clean cloth.  This stuff will eat your hands, it's basically bleach packaged in either sheets or spray, but the fact that you have to spray, wipe, spray, sit, then wipe, makes for a long time to clean a room.  When you are stacking them up in the hall way, it kinda sucks trying to get a clean room and a fast turn around.  When we are busy I have the patient stand or sit outside the room as I clean it, so they know we aren't jacking around and really are busy.

Some of you all raised the washing hands with chemicals, I thought most studies have shown correct hand washing is better than any of the chemicals?  I've been a hand washing nazi, especially since we have new Paramedic's to RN's that are used to the field where they can't wash and have to use chemical crap, I hated that on the squad, would wash like crazy when we got to the hospital, even if I did foam, gloves, foam, it doesn't feel the same.

Did neither of you guys take biology in high school?   :awesome_for_real:

I read this article as well a few months ago.  Its astonishing but the primary literature seems to indicate that this actually did "cure" more than one patient.  Now I think the one complication here is that bone marrow transplants or human neutriphill transplants don't always take to the new host.