HIV - When the Cure is Worse Than the Disease
HIV Cures by Bone Marrow Transplantion Are Potentially Deadly
In today’s culture, popular language surrounding health care is very combative. People “fight off the flu”, “lose battles against cancer”, and antibiotics “combat disease.” This language has caused people to see disease as a “win-lose” scenario where being “cured” means being rid of the disease, and anything less than a “cure” is an inferior solution. While in the past it was accepted that people had to live with some diseases, it is now expected that medical science should try and cure all. The recent claim of a cure for HIV illustrates the fault with this attitude: sometimes the cure is worse than the disease.
The HIV “Cure”
Dr. Gero Huetter, a German physician, gave an HIV positive leukemia patient a bone marrow transplant (BMT) using the bone marrow of someone with a natural resistance to HIV. These resistant individuals have non-functioning CCR5 proteins, a protein which HIV uses as a ‘door of entry’ to infect cells. After receiving a bone marrow transplant, Dr. Huetter’s patient has gone 20 months without the HIV virus being detectable in his system, and Dr. Huetter has declared him functionally cured. Beyond the fact that this claim is slightly early at this point (HIV is notoriously good at hiding, has a multi-year latency period, and the patient had HIV present that used a protein other than CCR5), the usefulness of this cure as a treatment is limited.
An HIV Cure Often Worse Than the Disease
Sources such as the Daily Kos have heralded this discovery as a huge breakthrough for HIV research, and accused the media and the medical community of harbouring bias for not giving it attention. The truth is, that beyond treating HIV positive leukemia patients, this cure is of limited usefulness as a treatment; Dr. Huetter has pointed out that Bone Marrow Transplant's have up to a 30% mortality rate, far too high for the treatment of a chronic illness. Thanks to HAART and other medications, most people can manage their HIV and live a full life (life expectancy is a median 32 years from infection with proper HAART treatment, a number which will increase before any HAART patients reach it). In rare cases where HAART is ineffective, most patients have 9-10 years before AIDS develops. Where HAART is effective, living with HIV is an obviously superior option to trying to have it cured via BMT, which comes with up to a 30% chance of death, reduced life expectancy, and almost certain long term side effects. Where HAART is ineffective it is still not clear whether receiving a bone marrow transplant, with as high as a one-in-three chance of dying, or foregoing treatment and living the next ten years to the fullest would be preferable, particularly when significant advances in HIV treatment could be made within that time.
Striving For Optimal Health Care
Some types of autoimmune disorders, cardiovascular disease, and cancers are also best managed as chronic illnesses rather than being treated for cures. In some cases medical intervention even for chronic maintenance is not preferable where it would significantly impact quality of life. As shown in the June 29th issue of Time, and studied extensively at Dartmouth Medical College, North America's society and its medical community are oriented towards providing the highest amount of treatment possible. Because of this it can be difficult to make the choice to live passively with “a defect” in a society which prizes taking action, the medical legacy of which stretches back to the 18th and 19th century practice of "Heroic Medicine".
Now that prominent medical schools such as Dartmouth have shown the problems with "overtreatment", the medical community has a clear and scientifically researched mandate to move away from being solely focused on cures and should instead orient itself towards achieving the optimum health outcomes for each individual. This does not suggest an end to research towards a cure for any illness, rather it suggests that the negative effects of some curative methods on patient health may render them inferior to chronic treatments so long as alternative cures are unavailable, which clinical practitioners would need to account for.
Bone Marrow Illustration
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