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Research Alert: Study Casts Doubt on "Shock and Kill" Cure Strategy

HIV Frontlines: The Doctor Who Cured HIV

An Interview With Gero Hütter, M.D.

June 19, 2012

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When you first thought to do this, this was a shot in the dark, right? Timothy's prognosis was pretty grim. No one had actually attempted this type of treatment before. Did you think, "Might as well give it a shot"?

Yeah. I would have felt better if I had tested it before. [Laughs] I knew it was probably possible. It's not easy to test the same condition in animals, but you could see some effects in animals.

In this case, it was clearly a shot in the dark. I studied the literature. I looked in PubMed, up and down, to see if there was anything published on this point: What happens if a patient who is HIV infected changes the CCR5 phenotype? And I found absolutely nothing. It's never been tested before, not even in vitro.

This was very surprising. It could be that no one really thought about this possibility. And the other explanation could be that they have tested it, it's gone wrong and no one got published. I was a little bit nervous about this point.

We were a little bit scared that we didn't really know what could happen: You have high selective pressure against the virus, when we changed this immune system to CCR5 depleted cells, and no one really could say how the virus would behave.

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[But then we realized that] the worst thing would be that he changes his tropism to the CXCR4 receptor, and then as long as he takes his antiretroviral medication, there's no harm for the patient. So we got optimistic that we could dare this experiment and that the risks are not too, too big.

I think it's easy for a lot of us to grasp on to this and say, "Here is the cure. Here is the future. Here is where it's going to happen." I'm guessing you've heard this kind of question a lot: "Is this the path forward?"

Yeah. If you look at the HIV research, we have no better answers for cure questions than what we have now with the CCR5 receptor, gene therapy. We have approaches in targeting, unmasking and killing, specifically, reservoir cells. But they are all connected with the cure question.

And the cure question, 10 or 5 years ago, was no real question. If someone said to you, "I want to cure HIV," all you'd have to say is, "You're mad. This is not possible. This is a retrovirus which degrades, and you can't get rid of the genomic material." This was the dogma of this case.

The way of thinking about cure has changed a little bit. This makes the process open for alternatives to the current antiretroviral therapy -- it does not have to be only the stem cell approach. There are other approaches derived from this case, which are also promising.

We've known for a while that the CCR5 receptor is the primary way through which HIV enters a CD4 cell. But there's still so much that we don't really know about the CCR5 receptor. How much have we learned over the past few years?

Very little. We know that the CCR5 deletion is much older than HIV, and the mutation appeared thousands of years ago. The distribution, what we see now -- in Europeans, this deletion is high; in Africans and Asians it is absent -- this is a distribution which happened in the last 10,000 years. There must be some kind of advantage for these carriers, and we don't know all the reasons why.

We don't know exactly the function of CCR5. We know that it probably plays a role in another infection, the West Nile virus infection. But all of the details are very unclear. There are some studies focusing on carriers of the CCR5 deletion, and whether they have high risk of any other disease. But these associations are very weak; there's no clear association of any disease with the deletion.

Why hasn't there been a Patient No. 2 yet?

We have had requests from other institutions -- taken together, I think we have now 15 other patients with HIV in need of urgent transplantation, because of leukemia, lymphoma, and so on. And some of them had just one [potential donor match]. Who gets that donor that was tested and was CCR5 negative?

Some had many potential donors -- 60, 120, such as Timothy had -- but sometimes mathematics fail. And the probabilities [of success] are 1 percent.

So this is a problem. I think it's a question of time. If you wait long enough, you will find a patient who will have the same conditions like Timothy.

The other point is that we don't have access to every patient who has the possibility to do this. There are many more patients with HIV who get transplants by allogeneic transplantation than we get information about. Because some institutions didn't really know about [the Timothy Brown] case. Some knew about this case and said, "Oh, this is so uncommon, this mutation; it doesn't make sense to test for it." They didn't start with it. If you don't start with the investigation, you will never find a second patient.

This is the biggest problem, I think: We have information about less than 5 percent of all these patients who get transplantation. If we have access to all of these and test them, the probability is much more higher to find a second patient.

Is this a uniquely European thing that you did? Could what you did with Timothy Brown not have been done anywhere else?

No: They tried it, too, in the U.S. But the circumstances are not like in Europe, or especially not Germany. We have in Germany a unique situation: We have 80 million Germans, and 3.5 million of them are registered in donor registries. It's very high. It's the highest proportion in the whole world.

Do you know how that compares to the U.S.?

You have 7 to 8 million in the U.S. But the difference, the second difference, is: These 8 million in the U.S. are derived from hundreds of stem cell registries. Every county, every state, every hospital, every institution has its own registry. And in Germany we have a central registry for all of these. So it's much easier to assess these registered donors.

That's also the reason why it works so well. You can do this in any country, but it works so well [in Germany] because we have this central registry, with a large number of registered donors. This was part of the success.

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Reader Comments:

Comment by: say mr moneybags (harare zimbabwe) Wed., Jan. 2, 2013 at 8:22 am EST
Interesting to know there others who care for total cure.its woth a try
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Comment by: Fahad (Jinja, UGANDA) Mon., Dec. 31, 2012 at 2:48 pm EST
Can this transplant be applied to even the poor African countries, because HIV is on our neck.
I beg that let thee be trials in Uganda too and I take part of the participation , I am dreaming of being cured.

Thanks
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Comment by: Lori Haserl (White Plains, NY) Sat., Dec. 1, 2012 at 8:33 am EST
This statement, that someone was "cured" from the HIV virus is inncorrect. While his body has picked up a DNA instruction that now creates HIV resistance in the body, the HIV virus is still laying dormant in his body.If he was "cured" by standard definition of the word cured, then the virus would no longer be in his system. While i commend Dr. Gero Hutter, i would like to tell the author and the readers that the HIV path was stopped, not removed.
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Comment by: andrew (san francisco, ca) Sun., Sep. 16, 2012 at 9:28 pm EDT
this may be obvious to most, but just to underline it, modern medicine is really pretty amazing
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Comment by: Jair G (Monterrey, México) Wed., Aug. 1, 2012 at 9:29 am EDT
amazing and hopeful...
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Comment by: neeta (india) Mon., Jul. 23, 2012 at 5:43 pm EDT
well done dr.hutter AND TERRI WILDER! God bless u!MY REQUEST TO U-KINDLY PROMOTE THIS INFORMATION TO MAXIMUM POPULATION OF WORLD,SO THAT WE ALL PEOPLE CAN PROVIDE OUR ANY POSSIBLE HELP,CONTRIBUTION TO U TO MAKE THIS RESEARCH A SUCCESS.PLEASE DEVICE A PROVISION TO MAKE US SEND MONETORY,OTHER COMTRIBUTION TO U DIRECTLY FOR SUCCES OF THIS RESEARCH.MAKE U R OWN TRIALS AND RESEARCH.GOD BLES!
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Comment by: lolki (wis) Sat., Jul. 21, 2012 at 2:52 pm EDT
it's obvious why there is no mainstream cure for hiv/aids there's more money to be made treating disease over curing them
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Comment by: Lucy Q (Los Angeles, Ca ) Tue., Jul. 17, 2012 at 2:32 am EDT
Its so wounderful 2 read this :) , I was diegnosed HIV+ in May/2012 I was beyond scared . I'm reading into it know but the first few weeks I was 2 scared 2 do so . I'm keeping the faith always and this reading gives Me even more hope * May God give U the ability N B right by your side on your wounderful research * - Amen
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Comment by: Girish C. (India) Wed., Jul. 11, 2012 at 3:31 am EDT
Amazing and really unbelievable
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Comment by: salmina (south africa) Sun., Jul. 8, 2012 at 6:33 pm EDT
The story is being told of the lucky patient, what else can be done to the millions of people?Or is this pandemic the last to end the world?
It sounds strange everytime when anything promising come to forth, the issue of funding rises to its peak.
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Comment by: Michelle (Bronx) Sun., Jul. 8, 2012 at 2:58 am EDT
I believe that there should be some clinical trials in the New York area of the CCR5 trial so that you can find out just how many people have it or don't have it. I believe people would be willing to show up even if they are not given incentative just for the fact it could help cure/save their life.
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Comment by: Papa PPZ (South Africa) Fri., Jul. 6, 2012 at 7:55 pm EDT
People are dying of HIV/AIDS an offer can be made to the Dr and he can cure de world.He can help the whole world.
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Comment by: mr L (US) Fri., Jul. 6, 2012 at 1:23 pm EDT
Why people don't postively to hurry the for hiv
cure this unwanted desases or scientistic need more people die intention because that is clear Brown has already cured why don't accept the medicine to be supply all over the world.
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Comment by: michael (los angeles) Tue., Jun. 26, 2012 at 4:07 pm EDT
here is a doctor who made a profound discovery and is trying to reach out to the whole community to come together and combine information, and then the world, especially the US ignores him and decides to do it by themselves...why? this is what happens when you try to make profit from the medical field. everybody wants to do their own thing so they can make a quick buck faster than the other guy........instead of welcoming this doctor's appeal to combine testing and create a central database for stem cells and a master list of people with no ccr5, they say no thanks.....this is sickening.
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Comment by: Miss Lee (SA ) Mon., Jun. 25, 2012 at 4:03 am EDT
Thats the best news ever - so why are you healing the rest of the world
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Comment by: Maria (South Africa) Fri., Jun. 22, 2012 at 2:00 pm EDT
thanks for the wonderful interview. I wish the medical doctors and researchers in this field start to realise how people are suffering and let them continue with the research for free for the benefit of the society. may God bless the DR who saved a life through this research and I wish he be supported. As a south africa who is HIV positive I feel like flying to Berlin to safe my life irrespective of the cost
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Comment by: Duncan (Dunedin, New Zealand.) Fri., Jun. 22, 2012 at 9:56 am EDT
Gero Hütter is a hero and a model for doctors worldwide! Medics with him motivations and his resources are the medics who are going to find THE CURE for this terrible disease we suffer from.

Thanks for the article, Myles. Keep publicising Gero Hütter. Make medics in other labs around the world sit up, take note, and copy his behaviour!
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Comment by: Luciano A (Mozambique) Thu., Jun. 21, 2012 at 2:53 pm EDT
I am HIV positive,discovered 1 year ago,i havent started with any treatment.
What can i do do be cured?
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Replies to this comment:
Comment by: michael (los angeles) Tue., Jul. 31, 2012 at 6:05 am EDT
bombard your congressmen and government to expand stem cell research.


Comment by: Pauline Asgarali (Trinidad and Tobago....) Thu., Jun. 21, 2012 at 2:48 pm EDT
Angels Forever Foundation team support this information and we thank u 4 bringing to the people'.....god' bless every 1'....
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Comment by: nelson vergel (The Moon) Thu., Jun. 21, 2012 at 2:19 pm EDT
Love the article, Myles!!
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