Known as the “Berlin patient,” British-born Timothy Ray Brown became the first person in history to be cured of human immunodeficiency virus (HIV), the illness that can lead to acquired immune deficiency syndrome (AIDS). The groundbreaking achievement happened over a decade ago and since then insights gained have seen a further two patients functionally cured of HIV. It was announced by the International AIDS Society (IAS) on Wednesday that Brown recently died following a battle with cancer, but his story remains a symbol of hope for the tens of millions of people living with HIV.
Brown’s acute myeloid leukemia diagnosis came about 10 years after his HIV diagnosis, and later became an integral part of his treatment for both diseases. At the Free University of Berlin he received a “two birds one stone” stem cell transplant taken from a donor who had a rare genetic mutation that made him resistant to HIV. Following the first bone marrow transplant in 2007, Brown had a second in 2008 and was declared free of both illnesses. The first transplant cleared him of HIV, and he remained clear until his death. The second transplant was to eliminate his leukemia, and after years in remission, it returned last year to his spine and brain.
"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," said IAS President Adeeba Kamarulzaman in a statement.
Earlier this year, another patient known as the “London patient” became the second person ever to have been functionally cured of HIV following a similar treatment of stem cells from a HIV-resistant donor. After contracting HIV this patient was diagnosed with a type of blood cancer called Hodgkin’s Lymphoma and received a stem cell treatment that, as well as being resistant to HIV, can tolerate chemotherapy drugs. Unlike Brown, they didn’t require full-body irradiation or a second round of stem cell transplantation. They later came forward as Adam Castillejo, a 40-year-old Londoner born in Venezuela who decided to reject his anonymity and become “an ambassador of hope”.
Further steps have been made in the treatment of the virus. In July it was published in Nature that a novel long-acting treatment had been found to be effective against multiple strains of the virus including those resistant to antiretroviral agents. It works by targeting the shell of the virus where the pathogen’s genetic material is stored and preventing it from replicating.
Further good news came in August when a phase I trial into a single gene therapy treatment began. The therapy, designed by American Gene Technologies and the National Institute of Allergy and Infectious Disease, began enrollment for the trial in September with hopes of an initial progress report to be released by the end of the year.
While case studies and data remain few and far apart, the determination of these patients, their clinicians, and researchers in committing to finding a cure for this disease constitute a critical contribution to medical science.
“Although the cases of Timothy and Adam are not a viable large-scale strategy for a cure, they do represent a critical moment in the search for an HIV cure,” said Professor Sharon Lewin, President-Elect of the IAS. “Timothy was a champion and advocate for keeping an HIV cure on the political and scientific agenda. It is the hope of the scientific community that one day we can honour his legacy with a safe, cost-effective and widely accessible strategy to achieve HIV remission and cure using gene editing or techniques that boost immune control.”