Success Stories of HIV/AIDS Treatment: The Berlin Patient and the Mississippi Toddler

Success Stories of HIV/AIDS Treatment: The Berlin Patient and the Mississippi Toddler

Timothy Brown on cover page of POZ after the "cure"

“Five years ago, (a cure) was impossible — we would never succeed, don’t even think of it, Now it’s becoming a reality.”                                                                                       ~Jean Perry Routy


The story of a Mississippi toddler cured of HIV shook the world this week; she is only child and the second person reportedly cured of HIV; the first person being “The Berlin Man” Timothy Ray Brown of San Francisco. His case was first reported in the media 5 years back in 2008 and described in the New England Journal of Medicine in 2009(click to read the original research paper)


The Fist Mention of HIV/ AIDS(Click the picture to read the
original Report)
The HIV/AIDS first came into picture in early 1980s, On June 5 1981, the CDC's Morbidity and Mortality Weekly Report published the first mention of what later is determined to be HIV. The report mentions five cases of Pneumocystis carinii pneumonia in young men. The piece prompts reporting from New York, San Francisco and other cities of similar cases.

Since then in just over 30 years the epidemic has killed over 25 million people and infects over 34 million all around the world and grown to be the deadliest disease that mankind has ever seen.

Once thought incurable recent happenings has shown how the virus is supposed to be dealt with.

The Mississippi Toddler(2013)

A meme of the cure at blog.lass.org.uk
The child's story is the first account of an infant achieving a so-called functional cure, a never seen before event in which a person achieves remission without the need for drugs and standard blood tests show no signs that the virus is making copies of itself.

More testing needs to be done to see if the treatment would have the same effect on other children, but the results could change the way high-risk babies are treated and possibly lead to a cure for children with HIV, the virus that causes AIDS.

"This is a proof of concept that HIV can be potentially curable in infants," said Dr Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, presenting  the findings at the Conference on Retroviruses and Opportunistic Infections in Atlanta.

When the baby girl was born in a rural hospital, her mother had just tested positive for HIV infection. Because her mother had not received any prenatal HIV treatment, doctors knew the child was born at high risk of being infected. So they transferred the baby to the University of Mississippi Medical Center in Jackson, where she came under the care of Dr Hannah Gay, a pediatric HIV specialist.

Because of her high infection risk, Dr Gay put the infant on a cocktail of three standard HIV-fighting drugs when she was just 30 hours old, even before lab tests came back confirming her infection. In more typical pregnancies when an HIV-infected mother has been given drugs to reduce the risk of transmission to her child, the baby would only have been given a single drug to reduce her infection risk.

After starting on treatment, the baby's immune system responded and tests showed levels of the virus were diminishing until it was undetectable 29 days after birth.

The Berlin Man and Boston Aftermath(2007)

Gero Hutter's post in New England Journal of Medicine
The Berlin Man, Timothy Ray Brown was diagnosed of HIV in 1995 and had been taking Anti Retroviral ever since to avoid full-blown AIDS.

Originally resident of US Brown had moved to Berlin, Germany in 1993. In 2006, he also developed leukemia. Poor fellow (un)lucky enough was then suffering from two of the deadliest disease that mankind had ever seen. (and is now cured of both)

Brown underwent chemotherapy but needed a blood stem cell transplant and turned to Gero Hutter, a blood specialist at Heidelberg University.

Hutter suggested they seek a donor with a certain cell feature that gives them natural resistance to HIV infection. Hutter theorized that a transplant from such a donor could make the recipient resistant to HIV.
Timothy Ray Brown
In an interview with AFP Hutter said no one apparently had tried this, and his idea received mixed reaction from other doctors. "Some were very excited, but many were skeptical," he said.

“Fortunately for me, I developed Leukemia” (look at the irony) Brown said in one of his interview after his cure.

Timothy, diagnosed with acute myeloid leukemia, received two bone marrow transplants from a donor who had a 32 base-pair deletion in the CCR5 gene, a mutation called Δ32.(for research articles click the numbers following. Research One, Research Two) CCR5 is almost always required for HIV to enter immune cells. People who are homozygous for the Δ32 mutation have natural resistance to HIV. These mutant cells completely repopulated Timothy’s immune system, giving him resistance to clear the virus.

Timothy, who had to go off antiretroviral therapy (ART) in 2007(for bone marrow transplant, he had to quit ARV therapy), has never gone back on medication.  This is called a “functional cure,” Timothy may or may not have virus hidden in his body, as has been recently debated, but Timothy remains off therapy; and “functionally cured” (I am not stating cured)

Boston Aftermath (2010)

In 2010, Dr. Tim Henrich, a fellow at Brigham and Women’s Hospital and  Dr. Daniel Kuritzkes, director of AIDS research at Brigham & Women’s Hospital looking at the curious case of The Berlin Patient concluded that even without transplanting HIV resistant cells it’s possible to eradicate HIV by maintaining antiretroviral therapy.

The Brigham team analyzed peripheral blood samples from two HIV+ patients at the Dana-Farber Cancer Institute who underwent hematopoietic stem cell transplants for treatment of lymphoma.
What they found out through the research was absolutely astounding- the latent virus (that pool of HIV unreachable by standard therapy) became undetectable following the transplant and has remained so for 2 and 3.5 years for each patient respectively.

The researchers believe that by keeping the patients on ART, the donor cells were protected from HIV. These donor cells then repopulated the patients’ immune systems, effectively clearing the virus. This data was announced, to an excited audience, at the recent International AIDS Conference held in Washington, DC.

They continued their research with other patients and the team is taking part in several studies looking at whether it is possible to eradicate the reservoirs of virus in adults that should have results within a year.

But a third patient he was treating suffered a relapse of lymphoma and died. “It sort of underscores what these patients have been through,” he said. No one thinks a bone marrow transplant represents a real-life treatment for anyone with HIV, because it’s so hard on the body.

Unlike Timothy, the conditioning regimen the two patients received was minimal, meaning that they were able to continue on ART throughout the transplant.

“We’re never really going to be able to do bone marrow transplants in the millions of patients who are infected,” Kuritzkes said in a interview with NBC News “But if you can stimulate the virus and eliminate those cells, we can protect the remaining cells from being infected.”

So there are two different forms treatment strategies, one we use the traditional Anti Retro viral therapy which can suppress virus growth in the body or replace the body’s cell with the stem cell therapy!

These stories have come to the people who live with HIV/ AIDS as a new hope of life and social acceptance, but the way this news was hyped especially the story about the Mississippi Toddler it gives people hope that is not justified. First, all three of the cases represent a individual and merely a case report. The treatment of  HIV/AIDS is still at least a decade from now.

  The events however show that HIV can be cured(at least functionally) but these are not the absolute treatment for all the people who suffer from AIDS. These are very encouraging stories for scientist but more importantly it going to attract investors to fund for the research. The funds for studies treatment of HIV/AIDS have rapidly been declining since 2009(WHO).

It’s an encouraging time to be researching the virus, and, more importantly, to be living with HIV.

Arun Upreti is a aspiring writer medical student, social activist, and Cricket Enthusiast. He is currently working as news analyst in Cricnepal





 

2 comments:

Alina Prajapati said...

This is very informative,well researched article.The happy ending stories arises a glimpse of hope in every HIV/AIDS patient. I wish Nepal had these technology too to eradicate HIV in Nepal. However, It is true that in developing country like ours it is too expensive but we should increase giving awareness about these things..
Looking forward for more articles from Arun..:)

Dr Mark Oduma said...

I was diagnosed with HIV/AIDS for over 5 years which made loose my job and my relationship with my fiance after he discovered that i was having HIV, he departed from me i tried all my best to make him stays with me, but neglected me until a friend of mine on Facebook from India told me Great healer, who will restore my life back with his powerful healing spell, he sent me the email address and Phone Number to contact ( odumaspiritualtemple@gmail.com or call +2349036855913 ) and i quickly contacted him, and he said my condition can solved, that he will treat the disease immediately only if i can accept trust him and accept his terms and condition, i Agreed because i was so much in need of help by all means, so i did all he want from me and surprisingly on Sunday last week He sent me a text, that i should hurry up to the hospital for a checkup, which i truly did, i confirm from my doctor that i am now ( HIV NEGATIVE) my eyes filled with tears and joy, crying heavily because truly the disease deprived me of many things from my life, This is a Miracle, Please do not en-devour to contact him via odumaspiritualtemple@gmail.com or call +2349036855913 for healing and solution

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