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New Data on the Berlin Patient: Interpret With Caution

June 9, 2012

On Friday at the International Workshop on HIV & Hepatitis Virus Drug Resistance and Curative Strategies in Sitges, Spain, Steve Yukl from UCSF presented new data on the case of Timothy Brown, the "Berlin Patient." Yukl described multiple experiments performed by several independent laboratories with the aim of searching intensively for any signs of residual HIV infection in plasma, peripheral blood mononuclear cells (PBMC) and biopsies from the gut and cerebrospinal fluid (CSF). The nature of these analyses is a testament to Brown's extremely laudable willingness to undergo an array of unappealing procedures in order to advance research into curing HIV.

No infectious HIV was detectable in any sample (including samples containing huge numbers of cells). In most cases, no HIV RNA or DNA could be found either, but there were some exceptions: a minority of samples, analyzed by some labs, intermittently tested positive for extremely low levels of HIV RNA. A very small proportion of the rectal samples also tested positive for very low levels of HIV DNA. Genetic sequencing results were not available but the abstract indicates that the RNA positive samples did not show any relationship with each other or the original infecting HIV (a finding perhaps suggestive of PCR contamination). Levels of antibodies against HIV have continued to decline over 18 months of follow up, while CD4 and CD8 T cell counts have reached near normal levels. The researchers make it very clear that because the assays being used are at the limits of their sensitivity and specificity, it cannot and should not be concluded from these data that Brown is still infected. Although it is possible that there is some residual virus present and that Brown is a case of a "functional cure" rather than complete HIV eradication (or "sterilizing cure"), further work will be needed to explore that possibility. But it is far more likely that -- as the study authors state -- these new results are just evidence of the technological challenges associated with looking for miniscule amounts of viral genetic material.

Unfortunately, it is all too easy to envision the mainstream media picking up news of this presentation and wildly misinterpreting it (e.g. "Man Said Cured of HIV Still Infected!"). Alain Lafeuillade, who runs the biannual HIV Persistence Workshop and the HIV Reservoir Portal website, has not helped matters by writing a bizarrely misleading post on the study which suggests that the authors interpretation of the data is wrong and that Brown is either not cured, or -- in an even stranger piece of speculation -- that he may have been reinfected. The evidence supports neither claim.

In a related development, on June 7th the scientist Lawrence Petz held a press conference with Timothy Brown at a symposium in San Francisco on the use of cord blood to facilitate stem cell transplants. Petz revealed that around 100 cord blood donors homozygous for the CCR5 delta-32 deletion have been identified (out of 17,000 tested), and one HIV-positive individual in the Netherlands has recently received such a transplant as part of a course of treatment for another disease. Another similar transplant is to be performed soon for an HIV-positive individual in Madrid. These cases will be carefully followed to see if the beneficial outcome experienced by Timothy Brown can be duplicated.

Click here and scroll down to view the abstract of the study upon which this article is based.

Richard Jefferys is the coordinator of the Michael Palm HIV Basic Science, Vaccines & Prevention Project Weblog at the Treatment Action Group (TAG). The original blog post may be viewed here.




 

Reader Comments:

Comment by: rigo Sat., Dec. 29, 2012 at 9:55 am EST
its very great that they have found a way for a person to be cured of HIV, in the meantime the rest of HIV infected people will await eagerly that the Antiretroviral Medicines available now are improved for the aim should be to find meds that have less or almost no side effects. My sincere and intense plea to Pharmaceutical Companies in the world is: Please find ARV Meds with less Side Effects. Thank u very much for the work already done, but still we have a long way to go.
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Comment by: Edward (London, England.) Fri., Jun. 15, 2012 at 6:24 am EDT
Thank you, Richard Jefferys, for this fascinating and very clear report regarding Timothy Brown. (Timothy, if you are reading this, consider taking to an idyllic country lifestyle on a permanent basis so as to never be even able to place yourself at any risk of ever contracting HIV again!)

Your article is also valuable to me, Richard, because it is the first I have seen that advises of the two patients, one in Holland and one in Spain, who are undergoing a similar treatment to Timothy's.

Fingers crossed. We so desperately need The Cure.
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Comment by: Mike (San Francisco, CA) Thu., Jun. 14, 2012 at 2:03 pm EDT
Just say it. The guy is cured. It's pretty black and white. You either have HIV or you don't. With all the technology they have today, if he had it, it would be really obvious. That's the way it works for the other zillion people who take HIV tests.
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Comment by: Andres (Bogotá, CO) Thu., Jun. 14, 2012 at 1:19 pm EDT
Un gran paso para la cura total, presiento que no falta mucho
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Comment by: rita (little rock ar) Wed., Jun. 13, 2012 at 5:00 pm EDT
So when can we get cure
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