Sunday marks 30 years since the first AIDS cases were reported in the United States. And this anniversary brings fresh hope for something many had come to think was impossible: finding a cure.
The example is Timothy Ray Brown of San Francisco, the first person in the world apparently cured of AIDS. His treatment isn’t practical for wide use, but there are encouraging signs that other approaches might someday lead to a cure, or at least allow some people to control HIV without needing medication every day.
“I want to pull out all the stops to go for it,” though cure is still a difficult goal, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
For now, the focus remains on preventing new infections. With recent progress on novel ways to do that and a partially effective vaccine, “we’re starting to get the feel that we can really get our arms around this pandemic,” Fauci said.
More than 25 million people have died of AIDS since the first five cases were recognized in Los Angeles in 1981. More than 33 million people have HIV now, including more than 1 million in the United States.
About 2 million people die of the disease each year, mostly in poor countries that lack treatment. In the United States, though, newly diagnosed patients have a life expectancy only a few months shorter than people without HIV. Modern drugs are much easier to take, and many patients get by on a single pill a day.
But it wasn’t that way in 1995, when Brown, an American working as a translator in Berlin, learned he had HIV. He went on and off medicines because of side effects but was holding his own until 2006, when he was diagnosed with leukemia, a problem unrelated to HIV.
Dr. Gero Huetter, a blood-cancer expert at the University of Berlin, knew that a transplant of blood stem cells (doctors used to use bone marrow) was the best hope for curing Brown’s cancer. But he aimed even higher.
“I remembered something I had read in a 1996 report from a study of people who were exposed to HIV but didn’t get infected,” Huetter said.
These people had gene mutations that provide natural resistance to the virus. A registry turned up more than 200 possible bone-marrow donors, and Huetter started testing them for the HIV resistance gene. He hit pay dirt at No. 61, a German man living in the United States, about 25 years old.
Brown had the transplant in February 2007. A year later, his leukemia returned but the HIV did not. He had a second transplant in March 2008 from the same donor.
Now 45, Brown needs no medicines.
“He’s now four years off his antiretroviral therapy, and we have no evidence of HIV in any tissue or blood that we have tested,” even places where the virus can lie dormant for many years, Huetter said.
Brown’s success inspired scientists to try a similar but less harsh tactic: modifying some of a patient’s infection-fighting blood cells to contain the mutation and resist HIV. In theory, this would strengthen the immune system enough that people would no longer need to take HIV drugs to keep the virus suppressed.
Scientists recently tried this gene therapy in a couple dozen patients, including Matthew Sharp of suburban San Francisco. More than six months later, the number of his infection-fighting blood cells is “still significantly higher than baseline,” he said.
It will take more time to know whether gene therapy works and is safe. Experiments on dozens of patients are underway.
Other promising approaches to a cure try new ways to attack the dormant virus problem, Fauci said. They hinge on getting people tested and into care as soon as they become infected.
