Andrew Belonsky

Do and Don't Get Excited About AIDS 'Cure'

Filed By Andrew Belonsky | May 19, 2011 1:00 PM | comments

Filed in: Politics
Tags: AIDS cure, HIV/AIDS, Timothy Ray Brown Cure

Timothy Ray Brown is being hailed as a medical marvel. The 45-year-old man tested silencedeath-1.jpgpositive for HIV back in 1995 and, as he fought the retrovirus, also found out that he had Leukemia, a disease doctors hoped to fight with a bone-marrow transplant. It worked: the Leukemia disappeared. So too did Brown's HIV.

"I quit taking my HIV medication the day that I got the transplant and haven't had to take any since," said Brown, referred to by medical professionals as "The Berlin Patient."

"I'm cured of HIV. I had HIV, but I don't anymore."

Doctors believe that Brown's miraculous turnaround may be traced to the marrow that contained an immunity, perhaps one passed down from the days of the Black Plague, when certain people found themselves unaffected by the fatal disease.

If that's the case, then it's possible the marrow's life-saving element can be isolated and eventually mass produced, ending the disease's reign of terror once and for all.

"If you're able to take the white cells from someone and manipulate them so they're no longer infected, or infectable, no longer infectable by HIV, and those white cells become the whole immune system of that individual, you've got essentially a functional cure," said long-time AIDS researcher Dr. Jay Levy from University of California at San Francisco.

Levy and other doctors, however, urge caution, especially since marrow transplants may not work for everyone, and the process itself can be fatal.

"The Berlin Patient is a fascinating story, it's not one that can be generalized," insisted another respected HIV/AIDS researcher, Dr. Paul Volberding, also of UCSF.

Volberding did admit, however, that Brown's progress qualifies as "productive." And that's definitely true - for more reason than one.

There was a time when HIV/AIDS was the cause célèbre. The sudden onslaught of such a devastating disease, coupled in part with Ryan White's brave fight, opened the world's eyes, spurring celebrities, politicians and much of the public to join in the research battle. As time went on, however, the shock and awe of HIV's first wave faded away.

The disease became too common place, and the HIV/AIDS activist sphere lost its luster. As a positive friend lamented to me recently, "People don't care about AIDS."

As the once-animated movement lost momentum, people seemed to forget about the disease's prevalence: infection rates among twenty-somethings are again on the rise, according to the CDC.

News of Brown's "cure" could change all that: while surely we all must remain skeptical, the potential existence of a cure - so long thought a myth - should reinvigorate the public's interest and imagination in fighting HIV/AIDS, a realm where the possibility of victory has for long seemed impossible.

A development as monumental as Brown marks a turning point, not simply for the medical community, but for us all, and brings some hope to a battleground that once seemed impossibly one-sided. It's our collective duty, then, to seize this moment and use this hopeful uncertainty to reawaken the struggling HIV/AIDS movement.

Someone like Brown, and the prospect of a day without AIDS, comes along once in a blue moon. Wasting this watershed moment would be a moral and medical failure.

This piece originally appeared at Death and Taxes Magazine.

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So I wonder if people will be asking their doctors for bone marrow transplants soon...

The re:solve AIDS project is raising money to get a promising AIDS vaccine through human testing so that it can be produced and made available to everyone who needs it.

I agree that the social buzz about HIV has waned, but HIV remains the kind of medical cash cow it became in the 80's and 90's. An incredible amount of money, one that dwarfs many other health concerns, gets funneled into HIV education, programs and research. In the public health realm, everyone knows that if you want support, you need to add some kind of HIV feature, no matter what program or department you are.

People in other fields feel both thankfulness and disdain for what HIV brings in--on the one hand, almost no money goes to tuberculosis, but on the other hand, it is because every country has an HIV program that otherwise unlikely infrastructure is created for labs that tuberculosis efforts can use.

I'm relieved and excited for what this one isolated case represents--a moral victory if not a viable one, and one that will help revitalize people to not just give the significant amounts of money that continues to flow ambivalently toward HIV cure and therapy efforts (even if not as high as the big boom days), but to actually look at the research with new eyes and come out with a cure. A cure is no longer a "yet to be seen" abstract idea. Someone's been cured. Now find another means, even if this one cure isn't a stop along the way.

This man may have been "cured" in the sense that his body can remain healthy without meds -- but has he been "cured" in the sense that he cannot infect anyone? Also, has every indication of viral presence been eliminated from his body? Has he been "cured" in the sense that he can't become re-infected with either the same or a different strain of HIV?

Even if the answers to the last questions are all "NO" this is still a notable medical achievement -- but I wish only to point out that different scientists can have different criteria for what constitutes a full "cure" -- and I haven't seen info in the public press about this particular man that covers all these bases.

If this man is healthy, yet it is possible for him to infect others -- whew, watch the right wing nutjobs run with that one!

They seem to be discussing his white blood cell immunity, which indicates to me that the virus cannot infect his WBCs and therefore cannot reproduce, which means that it will no longer be in his system.

But that's just my take on it.

I agree with you as far as this goes ... in theory, immediately after his bone marrow transplant, his native, non-immune WBC's continue to get killed off while his new, immune WBC's are unaffected by the HIV, eventually populate his blood supply, and give him a functional immunity.

However, not all his bone marrow gets replaced -- with current technology, that would be impossible. This means that his body now has two strains of WBC's. If the old marrow continues to produce non-immune WBC's, the old WBC population could provide a low-volume tissue reservoir where the HIV could continue to reproduce, albeit at a low, non-damaging level.

It's questions like that, that bother me about this approach to "cure".

And importantly, I might point out in the above scenario, his blood and semen could remain infectious -- maybe only in theory, or maybe in fact.

Bob Roehr | May 20, 2011 1:08 PM

Sorry, but you're wrong on that point -- ALL of Brown's immune system was killed off by radiation and chemotherapy as part of standard therapy for lymphoma -- that includes all of his bone marrow. The bone marrow transplant created a completely new immune system after the old cells were killed off -- they were not killed off by HIV but by the chemo/radiation.

He does not have two sets of WBCs. There is no way that his blood would remain infectious. Furthermore, extremely sensitive testing has not been able to detect a single copy of HIV in Brown's body, and that includes blood and sperm, not to mention lymph nodes.

You are confusing what happened with Brown and the clinical trial of 6 patients using the Sangamo technology that modifies only CD4 cells.

Thank you! That answers many of my questions about this!

(As for your third paragraph, I am not confusing two different treatments because I have no knowledge about the 6 patients you speak of. I wrote what I did simply because I was trying to reason things out.)

However this develops it is an important breakthrough that opens new avenues in treating people. Let's hope the minds at work can exploit this knowledge to make a more applicable cure for everyone infected.

I agree that this is a major revelation in HIV/AIDS, but I fear that too many people who didn't read up on the story - the people who perhaps "don't care about AIDS," like your friend said - have jumped right to concluding that HIV/AIDS now has a cure. But it's very complicated, and this one individual case can't be universally applied to every case. With the huge expense of a bone marrow replacement, this isn't a viable solution to the problem. I'm sure you know that, and I'm sure HIV/AIDS activists know that, but I don't know if casual news readers understand that. That is, could this prompt even greater apathy?

I think all news reports I have been very fair in including the major caveats of this functional cure. So that being said, there isn't much more one can do beyond that for people who just aren't going to digest/read beyond the headline short of finding and sitting down with each one and having a Q&A. If they're not going to read the article, are they going to listen to the entire news broadcast/radio segment/elevator speech?

Good for this guy, but this sort of solution isn't going to be available to everyone soon.