Usually, when one is diagnosed with HIV/Aids, we easily give up our hope for life. We abandon every effort to live. Here I want to emphasise that there is still hope for life.
Timothy Brown, a 46-year-old from the western United States, was once known in medical journals as “the Berlin Patient.”
He is the man who had HIV but doesn’t anymore. Brown revealed his identity in 2010 - three years after an innovative treatment battled both the HIV and an acute form of cancer in his body. He now promotes Aids research.
“I do have some mobility problems, but apart from that, I feel great. Yes, it’s great being cured,” he said last month in Washington at a policy briefing organised by The Foundation for AIDS Research, or amfAR.
Doctors say he is the first person to be considered cured of HIV. “I am functionally cured, which means that I don’t have any effects from the virus, and I don’t have to take medication against the virus,” Brown said. “And as long as it stays that way, which I’m pretty sure it will, I’m okay with that.” Brown was living in Berlin when he tested positive for HIV in 1995. He took medications to manage the virus. More than a decade passed, and he started to feel excessively fatigued. A bone marrow biopsy in 2006 revealed leukemia.
After chemotherapy treatment, Brown’s oncologist, Gero Huetter, suggested a bone marrow transplant. Dr. Huetter knew that 1 out of 100 people, mostly northern Europeans, are highly resistant to HIV due to a genetic mutation. Simply put, they lack doorways that allow HIV to enter their cells. In 2007, Brown went through total body irradiation and then received a bone marrow transplant from an HIV-resistant donor. He immediately stopped taking HIV medication. Although the leukemia returned, the HIV did not. Brown was declared HIV NEGATIVE.
Researchers in the US are cautious in declaring the two other men cured more than two years after receiving bone marrow transplants.
These two new cases are reminiscent of the so-called “Berlin patient,” the only person known to have been cured of infection from the human immunodeficiency virus.
“Everyone knows about this ‘Berlin patient’. We wanted to see if a simpler treatment would do the same thing”, said Dr. Daniel Kuritzkes of Brigham and Women’s Hospital in Boston, who oversaw the study.
Aids patients are susceptible to cancers, but they usually stop taking HIV drugs before receiving cancer treatment. “That allows the virus to come back and it infects their donor cells,” Kuritzkes said.
Brown, and now these two other men, offer same real hope.
Dr. Timothy Henrich and colleagues at Brigham and Women’s Hospital launched a search about a year ago for HIV patients with leukemia or lymphoma who had received bone marrow stem cell transplants. Bone marrow is the body’s source of immune system cells that HIV infects and it’s a likely place to look for HIV’s reservoirs.
“If you took an HIV patient getting treated for various cancers, you can check the effect on the viral reservoirs of various cancer treatments,” Kuritzkes, who works with Henrich, said. They found the two patients by asking colleagues at Dana-Farber Cancer Institute in Boston which, like Brigham and Women’s, is associated with Harvard Medical School.
Both men had endured multiple rounds of treatment for lymphoma, both had stem cell treatments and both had stayed on their HIV drugs throughout. “They went through the transplants on therapy,” Kuritzkes said. It turns out that was key.
“We found that immediately before the transplant and after the transplant, HIV DNA was in the cells. As the patients’ cells were replaced by the donor cells, the HIV DNA disappeared,” Kuritzkes said. The donor cells, it appears, killed off and replaced the infected cells. And the HIV drugs protected the donor cells while they did it.
One patient is HIV-free two years later, and the other is seemingly uninfected three-and-a-half years later.
“They still have no detectable HIV DNA in their T-cells,” Kuritzkes said. In fact, doctors can’t find any trace of HIV in their bodies - not in their blood plasma, not when they grow cells in the lab dishes, not by the most sensitive tests.
Can the patients be told they are cured?
“We’re being very careful not to do that,” Kuritzkes said.
For now, both men are staying on AIDS drugs until they can be carefully taken off under experimental conditions. “We are not saying, ‘You are like the Berlin patient’.”
Although the men are HIV-free, Kuritzkes says it’s been an arduous experience for them. After being diagnosed HIV-positive, one underwent rounds of chemotherapy for Hodgkin’s disease, a kind of lymphoma, before receiving the final bone marrow transplant, called an allergenic bone marrow transplant. It is not an easy treatment to endure.
The men, one from Boston and one from New York, were not initially told their HIV had seemingly disappeared. When researchers realised news media would cover the report, they were informed.
“We’re never really going to be able to do bone marrow transplants in the millions of patients who are infected,” Kuritzkes said. “But if you can stimulate the virus and eliminate those cells, we can protect the remaining cells from being infected.”
Separately, two other studies presented at the conference have scientists optimistic about a cure. In one, a cancer drug called vorinostat flushed out latent HIV from a handful of patients, offering the possibility of killing these latent reservoirs. In another, about 15 French patients who got HIV drugs very early after their infections were able to stop treatment and don’t show any symptoms years later, even though they are still infected.
Organizers of the conference say the findings provide an argument for treating patients early. “(These studies) give us reason for enthusiasm, that ultimately we are going to get to where we needed to go, which is to cure people with HIV infection,” said Dr. Steven Deeks, an HIV expert at the University of California, San Francisco.