Will we cure HIV in our lifetime?

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Our bodies can do many amazing things.
They can heal our cuts and fight off diseases.
They can bear the fallout of our actions, to an extent.

Our bodies have many limitations, too. There are some things that have so far evaded both the resilience of our bodies and years of our combined mental ingenuity — where we have employed medical knowledge and research to make up for our bodies’ deficiencies.

Since 1981, and for a good number of years before its official recognition, human immunodeficiency virus (HIV) has been one of the most evasive and widespread viruses that has overwhelmed not only our bodies, but also the extent of our medical capabilities. For years, we believed that, while we could manage HIV — affording a sort of rocky co-existence between the virus and our bodies — a cure would never be found.

In 2009, Timothy Brown, along with his oncologist, Gero Hütter, demonstrated that life rarely presents us with absolutes. Brown — who for years was only known to the public by the moniker “The Berlin Patient” — became the first man in history to be declared cured of HIV.

Two threats, one treatment

Living in Berlin at the time, Seattle-born Timothy Brown contracted HIV in 1995. Fortunately, the advent of new anti-retroviral drugs in 1996 allowed people with HIV to live longer and healthier lives. Brown became used to this relatively healthy life. But in 2006 he developed a second life-threatening disease: leukemia.

After an initial bout of chemotherapy, Brown’s leukemia started to go into remission. However, when it came back in January 2007, it became clear that a stem-cell transplant was necessary.

It was around this time that Brown’s oncologist, Dr. Hütter — a doctor who had no previous background in HIV medical research — made a suggestion that would eventually materialize into a possible cure for one of the world’s most devastating diseases. A cure for one man, at least.

Hütter had casually come across studies that showed the HIV virus attaches itself to a certain type of cells in our body called T-cells (cells that are responsible for fighting off diseases — immune system response cells). Many strains of the virus attach themselves to these cells via a certain type of receptor (called a CCR5 receptor), and use the cell to reproduce. When HIV takes over enough of these T-cells, the viral infection develops into AIDS and leaves the body fatally vulnerable to even the most placid illnesses, like the common flu.

However, people with a particular genetic mutation that’s present in about one per cent of the European population do not have the CCR5 receptor — the major co-receptor that HIV uses to infect the body. So such people have a natural resistance to HIV. Since Brown required a stem-cell transplant anyway, Hütter used stem cells from someone with this HIV-resistant mutation.

His ingenuity paid off — Brown stopped taking his HIV drugs the day of the transplant and never took them again. After repeated tests, a 2009 article was published in the New England Journal of Medicine, tentatively declaring Brown cured of HIV.

The Berlin Patient speaks

Brown says that he was initially reluctant to attempt the treatment.

“My initial thoughts were that I basically just wanted to be cured of the leukemia,” says soft-spoken Brown, recalling the first time the experimental treatment came up. “I thought it was a great idea, but I didn’t really believe that it would work.”

At first, Brown turned down the stem-cell transplant option — stem-cell transplants are notoriously difficult on the body, and incredibly risky. When it became clear that there were no other options, Brown consented to receiving the transplant.

Brown has not recovered completely from complications arising from the procedure, but he is both leukemia- and HIV-free. He still undergoes regular testing to ensure that the virus is not present in his body, and also gives regular blood samples to medical researchers across the United States.

There is some controversy over whether or not Brown is completely rid of the virus. This past June at the International Workshop on HIV & Hepatitis Virus in Spain, a San Francisco-based research group claimed that they had in fact detected very low levels of infected cells in samples they had collected from Brown. However, the report they published states that it is “impossible to conclude” that Brown remains infected. This, coupled with the fact that other labs have done similar tests with no results, and that the viral genes don’t completely match samples of Brown’s HIV before the transplant, suggest that the test results may be due to a sample contamination.

Regardless of whether or not the findings are accurate, Brown is still considered functionally cured, meaning that even if some virus particles remain present, the virus is not actively replicating.

Brown said after the conference that rumors that he is not cured (or even worse, that he has become re-infected) upset him, and have been difficult to read.  Perhaps it was out of fear of episodes like this that for years Brown was reluctant to make his identity public.

“I did an interview in 2009 with a German newspaper . . . Die Zeit. When I did that interview, I asked them not to use my name,” says Brown, who was still recovering physically and emotionally at that time, and at some points could not even walk or clean himself. 

“I began to realize in 2010 that I needed to come out and be an advocate for other people to find a cure for HIV.”

The Timothy Ray Brown Foundation

Since 2010, Brown has focused on being an activist for the cure of HIV. Brown’s specific cure is not practical on a wide-range scale (due to its high risk, difficulty on the body, shortage of donors, cost and so on), but researchers are taking what they’ve learned from Brown’s case and are attempting to use that knowledge to work on more feasible cures. For instance, Brown mentions one attempt that focuses on removing HIV-susceptible receptors from T-cells without resort to a transplant.

At the International AIDS conference in Washington, D.C., in July, Brown announced his new foundation, the Timothy Ray Brown Foundation, which he started with assistance from the World AIDS Institute (a pre-established charity dedicated to documenting and preserving the history of the pandemic). Brown’s organization is the only charity whose sole purpose is to secure funds for cure research. Because modern-day anti-retroviral drugs are effective and improving all the time, and because a cure for HIV was previously thought impossible, most research is geared towards improving these sorts of drugs. Studies have shown that improvements to the drugs have advanced to the point where the average life expectancy of those who receive an early diagnosis and proper treatment is only around seven years shorter than someone without the virus.

Despite the significant increase in life expectancy since 1996, when anti-retrovirals first came out, both Brown and one of the co-founders of The World AIDS Institute, Chad Johnson, are adamant that one of the most important things to do for those living with HIV is not only to make sure they’re looked after and have proper access to medical care, but also to work towards finding a cure.

“From my perspective, the way that we can really help people is that we can be investing a whole lot more resources into finding a cure,” says Johnson, who has been involved in civil rights work for over 20 years and first partnered with Brown after a chance meeting at a conference.  Johnson notes that although the United States government is planning to invest $2 to $3 billion into cure research in the next two years, it’s not enough.

“We’re really behind the game,“ says Johnson. “Look at [Brown’s] example and you can see there is a cure. If there is one person who can be cured, we can cure this thing. All we need is the right political and social will to make it happen. Our job is to make sure that hope is out there.”

The possibility of finding a cure seems more likely all the time. At the International AIDS Conference this year, researchers from Harvard presented a report detailing the cases of two other patients who underwent a similar procedure to Brown. So far, no traces of the virus have been found in their blood samples. However, researchers maintain that it is still too soon to claim that they have been cured — both patients are still on anti-retroviral medication, and would need to go off the medication for a prolonged period of time to be sure that the virus is truly gone.

The main difference is that while Brown’s stem cells came from a donor with the CCR5 mutation, the two other patients’ donors did not. This demonstrates that even though the CCR5 mutation might have helped with Brown’s cure, it may not be necessary to the procedure.

Wherever this research leads, it has given people living with HIV hope for the future. Brown’s best advice for those living with HIV? “Don’t give up hope, because a cure is on the horizon!”

Brown’s story is one that documents both the unique ability of human ingenuity to step in and help cure the body when it is unable to cure itself, and the resilience of body and spirit. After surviving two life-threatening illnesses and narrowly escaping death several times, Brown’s outlook remains positive.

“I joked to a friend of mine that I have nine lives, and he said I have at least a hundred,” says Brown. “I live my life as if I will live forever. Hopefully I will live for a long time. And I hope to be alive when there’s a cure for HIV for everyone.”

HIV timeline

1884–1925 – HIV thought to have been transferred to humans in this timeframe

Though scientists do not know for sure, HIV is thought to have originated in Africa. It is believed the virus reached the United States sometime around 1970.

1981 – First official report of AIDS virus

Often considered to be the year the AIDS epidemic started, the Centre for Disease Control and Prevention issued its first official report of the virus in 1981.

1982 – AIDS gets its name

A nameless epidemic up until 1982, AIDS was sometimes referred to as the “4H disease,” as at the time the virus primarily affected Homosexuals, Haitians, Hemophiliacs and Heroin users.

1988 – World AIDS day established

The World Health Organization establishes World AIDS Day on Dec. 1, 1988.

1995 – HAART becomes FDA approved

Highly Active Anti-Retroviral Therapy — a combined treatment program — slows the onset of AIDS and helps those who are HIV positive live longer lives.

1996 – UNAIDS established

The United Nations launches a co-ordinated global program dedicated to taking action against the HIV/AIDS epidemic.

2001 – 20th anniversary of first report of AIDS

An estimated 28.6 million people are living with AIDS in 2001.

2009 – Obama announces he will lift America’s travel and immigration ban

A previous ban on HIV positive people travelling or immigrating to the United States is officially lifted the following year, in 2010.

2010 – First man declared cured of HIV

After undergoing a stem-cell transplant, Timothy Brown is declared to be the first man cured of HIV

2012 – 34 million people living with AIDS

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