The world could be a savage place. Imagine being the first man cured of HIV, only later to die of cancer.
The first person to be cured of HIV, Timothy Ray Brown – known as the ‘Berlin Patient’– has died after a battle with cancer, the International Aids Society (IAS) announced Wednesday. The 54-year-old made medical history and became a symbol of hope for the tens of millions of people living with the virus that causes AIDS when he was cured of it in 2007.
Last week, he revealed that he had been living with leukemia for several months and was receiving hospice care at his home in Palm Springs. IAS President Adeeba Kamarulzaman announced his death on Tuesday in a statement. ‘On behalf of all its members… the IAS sends its condolences to Timothy´s partner, Tim, and his family and friends,’ said IAS President Adeeba Kamarulzaman.
‘We owe Timothy and his doctor, Gero Hutter, a great deal of gratitude for opening the door for scientists to explore the concept that a cure for HIV is possible.’
Brown was diagnosed with HIV while was studying in Berlin in 1995.
A decade later, he was diagnosed with leukemia, a cancer that affects the blood and bone marrow.
To treat his leukemia, his doctor at the Free University of Berlin used a stem cell transplant from a donor who had a rare genetic mutation that gave him natural resistance to HIV, hoping it may wipe out both diseases.
It took two painful and dangerous procedures, but it was a success: in 2008 Brown was declared free of the two ailments, and was initially dubbed ‘the Berlin Patient’ at a medical conference to preserve his anonymity.
Two years later, he decided to break his silence and went on to become a public figure, giving speeches and interviews and starting his own foundation.
‘I am living proof that there could be a cure for AIDS,’ he told AFP in 2012. ‘It’s very wonderful, being cured of HIV.’
While he remained cured of HIV, his cancer returned.
In an interview with The Associated Press recently, he said he was still glad he underwent the procedure.
‘I’m still glad that I had it. It opened up doors that weren’t there before’ he said.
Ten years after Brown was cured, a second HIV sufferer — dubbed ‘the London Patient’ — was revealed to be in remission 19 months after undergoing a similar procedure.
The patient, Adam Castillejo, is currently HIV-free.
In August a California woman was reported to have no traces of HIV despite not using an anti-retroviral treatment.
It is thought she may be the first person to be cured of HIV without undergoing the risky bone marrow treatment.
Sharon Lewin, president-elect of the IAS and director of the Doherty Institute in Melbourne, Australia, praised Brown as a ‘champion and advocate’ of a cure for HIV. ‘It is the hope of the scientific community that one day we can honor his legacy with a safe, cost-effective and widely accessible strategy to achieve HIV remission and curs using gene edition or techniques that boost immune control,’ she said.
HOW A STEM CELL TRANSPLANT CURED THE BERLIN PATIENT AND THE LONDON PATIENT
The vast majority of humans carry the gene CCR5. In many ways, it is incredibly unhelpful. It affects our odds of surviving and recovering from a stroke, according to recent research. And it is the main access point for HIV to overtake our immune systems.
But some people carry a mutation that prevents CCR5 from expressing itself, effectively blocking or eliminating the gene. Those few people in the world are called ‘elite controllers’ by HIV experts. They are naturally resistant to HIV.
If the virus ever entered their body, they would naturally ‘control’ the virus as if they were taking the virus-suppressing drugs that HIV patients require.
Both the Berlin patient and the London patient received stem cells donated from people with that crucial mutation.
WHY HAS IT NEVER WORKED BEFORE?
‘There are many reasons this hasn’t worked,’ Dr. Janet Siliciano, a leading HIV researcher at the Johns Hopkins University School of Medicine, said.
1. FINDING DONORS
‘It’s incredibly difficult to find HLA-matched bone marrow [i.e. someone with the same proteins in their blood as you],’ Dr. Siliciano said. ‘It’s even more difficult to find the CCR5 mutation.’
2. INEFFECTIVE TRANSPLANT LEADS TO CANCER RELAPSE
Second, there is always a risk that the bone marrow won’t ‘take’.
‘Sometimes you don’t become fully “chimeric”, meaning you still have a lot of your own cells.’
That is one of the two most common reasons for previous attempts failing: their immune system is not fully replaced, then the cancer comes back and they can’t survive it.
3. GRAFT-VERSUS-HOST DISEASE: THE OLD IMMUNE SYSTEM ATTACKS THE NEW ONE
The other most common reason this approach has failed is graft-versus-host disease.
That is when the patient’s immune system tries to attack the incoming, replacement immune system, causing a fatal reaction in most.
4. UNKNOWN QUANTITIES
Interestingly, both the Berlin patient and the London patient experienced complications that are normally lethal in most other cases. And experts believe that those complications helped their cases. Timothy Ray Brown, the Berlin patient, had both – his cancer returned and he developed graft-versus-host disease, putting him in a coma and requiring a second bone marrow transplant.
The London patient had one: he suffered from graft-versus-host disease. Against the odds, they both survived, HIV-free. Some believe that, ironically, graft-versus-host disease might have helped both of them to further obliterate their HIV. But there is no way to control or replicate that safely.