Cured patient, researchers discuss momentum of AIDS fight

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From left to right: Paula Cannon, Dr. Peter Hunt, Timothy Ray Brown, Dr. Susan J. Blumenthal, Dr. Keith Jerome, Dr. Robert Silicano

Timothy Ray Brown is an unassuming-looking man with a wide and ready smile. He moves a little slowly; he says he doesn’t get around as fast as he did before a bone marrow transplant nearly killed him. That isn’t what he came to Capitol Hill on Wednesday to talk about, though, or rather, that was just a small part of it. Brown is the Berlin Patient. He is the only person ever to be cured of HIV, a feat that, when he talks about it, sounds simpler than curing the leukemia he was being treated for at the time. He came to an amFAR briefing on HIV/AIDS research to tell that story, and to talk about what it means to everyone else.

Interviewed by PBS News Hour co-anchor Judy Woodruff at the event, which included panel discussions on recent work towards a cure for the virus that leads to AIDS and on policy implications, Brown began his story in 1995.

That was the year when he learned that he had HIV and that his immune system already had been badly damaged. “I was scared to death,” he said. Antiretroviral drug combinations became available the next year, though, and he did well and kept working for the next decade before he got leukemia.

An American who was studying and working abroad during the years leading up to his leukemia diagnosis, Brown has told the story of what happened next many times over the years since, but he still includes all of the details –- three grueling courses of chemotherapy leading to pneumonia before he had to take a break, and then the discovery that 232 compatible donors were available for a bone marrow transplant. All of that led to the decision by his oncologist, Dr. Gero Hutter, to check all 232, if necessary, to find one with the natural mutation that makes 1 percent of the population immune to HIV.

“That couldn’t have happened in America,” Brown said. Insurance rules wouldn’t have allowed continued testing after finding one compatible donor, he said. As it happened, the 67th donor had the immune trait.

That was in 2007. Brown took his last antiretroviral medicine before the transplant; none in the five years since. Although fragments of HIV genes recently have been detected at minute levels in some of his tissues, he is functionally cured. Doctors Wednesday continued to stress the virus no longer replicates in his body, nor is it transmissible.

The leukemia, as it turned out, was harder to get rid of. When he relapsed a year later, he received a second transplant from the same donor. This time, the ravages of the transplant attacked his brain, liver and kidneys, leaving him delirious, incontinent and immobile. Slowly, he said, he graduated from a wheelchair to a walker to walking on his own again.

“Where did you get the courage?” Woodruff asked him.

“I just didn’t want to die,” he said. “I wanted to stay alive.”

The doctors who followed Brown at Wednesday’s briefing told how the science behind his cure can be used to explore new answers – to use patient’s own stem cells, to learn to reproduce the trait that made Brown’s donor immune to HIV, to work with patients’ immune systems to attack the virus in other ways.

Finding a cure, they said, can be part of the solution to AIDS.

“No single strategy is likely to be 100 percent effective in eradicating HIV,” Dr. Peter Hunt, assistant professor of medicine at the HIV/AIDS Division at the University of California, San Francisco, who talked about his research into the role of immune responses on the health of HIV/AIDS patients. He was part of a panel that included: Dr. Robert Silicano, a researcher and professor in the Department of Molecular Biology and Genetics at Johns Hopkins University School of Medicine; Dr. Keith Jerome, professor of laboratory medicine and microbiology at the University of Washington and director of the UW Molecular Virology Laboratory and Paula Cannon, associate professor of molecular microbiology and immunology, pediatrics, biochemistry and molecular biology at the Keck School of Medicine of the University of Southern California.

While pointing out how highly active antiretroviral therapies reversed the steep climb in deaths caused by AIDS, Silicano added that continuing obstacles to good and consistent care in resource-poor countries remain “a recipe” for treatment failure.

A cure such as Brown’s will never be feasible globally, Silicano said after the panel, “the real value may be in teaching us things we didn’t understand,” he added.

And, said amfAR senior policy and medical advisor Susan Blumenthal, a cure would serve as proof that the will to tackle AIDS effectively existed. It could be, she said, “the moonshot of our generation.”

In addition, when a cure can reduce the numbers of patients, resources will be freed to attack the epidemic more aggressively, a second group of panelists said.

The second panel talked about the policies surrounding research past and present, and the potential impact of cuts in funding to future work to end AIDS.

“We’re at a moment of incredible opportunity,” said Chris Collins, amFAR vice president and director of public policy. “If this were a business, this is not the time to divest.”

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