A few years ago the “Berlin patient” Timothy Brown was the first patient, who has ever been successfully cured from HIV. Timothy Brown was chronic HIV -positive and diagnosed with a severe blood cancer, which is even in times of modern, sophisticated medicine (and dependent on many prognostic factors) in about 50% a deadly disease. He therefore needed a hematopoetic stem cell transplant (also called bone marrow transplant). His treating physician found a genetically fitting donor that had mutations in a receptor that HIV needs to enter cells (CCR5) thus making the cells resistant to HIV. After the successful treatment Timothy Brown survived and no HIV was detectable anymore.
The astonishing results of a single patient gave the HIV research community a new spark and researchers as well as the National Institute of Health to shift research directions and funding towards projects that may lead to a cure. These included approaches that mimic the treatment of Timothy Brown. Three patients in Boston were treated the same way, but none of them were cured. However, despite these sobering results similar approaches are still an important avenue that are currently considered in HIV cure research and will shape the cure research agenda in the coming years.
This year again another single case was heavily discussed in the news. The so-called “Mississippi Baby” seemed to have been functionally cured. She had contracted HIV at birth from her HIV-positive mother. Thirty hours after the baby was born, she was treated with intense antiretroviral therapy and HIV levels were undetectable in the absence of treatment. As a result, the National Institutes of Health planned to conduct a worldwide study on aggressive antiretroviral treatment of newborn infants of mothers with HIV infections. It was thought that aggressive antiretroviral therapy on newborn infants might be a cure for HIV. On July 10, 2014, however, it was reported that the child was found to be infected with HIV.
These studies reminded us of another case that similarly sparked hope that a cure may be within reach. The patient, who was also named the “Berlin patient” and identified almost 15 years ago had been treated with structured treatment interruption during acute HIV infection, but then stopped therapy and HIV became undetectable. (Read the original news article in the New York Times here). Likewise, HIV was discovered later in cells of the patient.
Given the cautionary tale to draw broad conclusions from a single patient, we decided to study the original “Berlin patient” again and show that most likely underlying genetics had caused his astonishing level of HIV control.