May 7, 2013
Given how much the phrase "HIV cure" has been thrown around lately by the media, you might start to think that we actually have one.
We don't. But we're getting closer.
In the past few years, a tiny -- but slowly growing -- number of people appear to have had active, living, reproducing HIV completely eliminated from their bodies. We say "appear" because this is uncharted territory, and we're not yet certain how to be absolutely sure that a person's HIV infection has been eradicated. For that reason, we tend to refer to these people not as "cured," but as "functionally cured."
Here's a quick look at the most solidly documented "functional HIV cure" cases we know of today -- and at one person whose functional cure may be settling in as you read this.
The "Berlin Patient"
In the beginning, there was Timothy Ray Brown. An American living in Berlin, Brown was diagnosed with HIV in 1995 -- and with advanced leukemia in 2006. His prognosis had become grim.
A German oncologist, Gero Hütter, M.D., decided to try the medical equivalent of a Hail Mary pass: A never-before-attempted stem cell transplant in which the donor had a rare mutation making him essentially immune to most forms of HIV.
The procedure was extremely risky -- and stunningly successful. Seven years later, Brown's leukemia remains in remission, and there is still no sign of active HIV anywhere in his body, though he has been off of HIV medications since shortly after his operation.
The Boston Duo
The success of the "Berlin patient" got researchers wondering: How easy might it be to replicate this miracle?
The short answer is: Not easy. The stem cell transplant procedure is very dangerous for the recipient, and is awfully expensive to boot. Nonetheless, in certain cases it may be deemed worth the risk. In 2012, researchers reported the cases of two HIV-positive men who had received stem cell transplants similar to the one Brown received. Unlike Brown, though, the donor cells they received were not resistant to HIV; finding a genetic match for such a rare mutation is extremely difficult.
However, the two men stayed on HIV treatment throughout the transplant process, which appears to have kept any remaining HIV in their bodies from infecting the new donor cells. While both men have thus far remained on HIV meds as a precaution, at last report they showed no traces of active HIV in their blood.
The VISCONTI Cohort
For some time now, many HIV experts have had a hypothesis: If people can be started on HIV treatment early enough -- very shortly after they are infected -- it might be possible to prevent HIV from establishing a permanent foothold in their body.
The VISCONTI study is one high-profile attempt to test this hypothesis. Fourteen people who started HIV treatment during acute (early-stage) infection were kept on medications for at least a year before stopping.
Surprisingly, researchers found that once they stopped treatment, these people were still able to control the virus -- their HIV viral load remained undetectable without them having to take meds, as though their immune system had been "trained" to be similar to that of the extremely small number of people who appear to have a natural ability to fight off the virus.
Much like people who receive successful cancer treatment are said to be "in remission," doctors are referring to these two people as being in "long-term functional remission" of their HIV infection.
The Mississippi Baby
The most recent story of a "cured" HIV-positive person came in March 2013. That's when we learned about a baby from Mississippi who had HIV at birth, but whose infection appears to have subsequently been wiped out.
Similar to the VISCONTI group, the key to success in this case appears to have been starting HIV treatment very early with the most potent drugs available. This is not the typical approach for babies born to HIV-positive mothers, in part because mothers have almost no chance of passing HIV to their children if they receive proper care before giving birth.
Nonetheless, the story of this baby provides additional hope that extremely early HIV treatment may help prevent HIV from gaining a foothold in a person.
The Wisconsin Pre-Teen
In April 2013, news arrived about a 12-year-old boy in Minnesota who had received a stem cell transplant using HIV-resistant donor cells to treat his HIV and leukemia.
Sound familiar? It should. It's the same procedure Timothy Ray Brown underwent, with one key difference: Instead of using bone marrow, the doctors used umbilical cord blood, which is easier to find a donor match for.
The procedure went well, in that the transplant operation itself was completed without complications. Now all we can do is sit tight and wait for word on whether the boy's HIV and leukemia have been functionally cured in the same manner as Brown's was.
Read More on the Cure
If this slide show has piqued your interest and you want to learn more about the search for a way to stop HIV/AIDS once and for all, take a look at the following articles: