If AIDS has been cured, why is the victory party so small?


This week, Gizmodo and a handful of other media outlets published a story about a man who was reportedly cured of AIDS. But run a Google search for "AIDS cure" today, and what you get is a mixed bag—some articles about this specific case, some herbal medicine quackery, some older stories about other doctors hoping for their own AIDS breakthroughs, and even a New York Times piece from earlier this year about why we haven't found a cure for AIDS yet. If a miracle happened, why isn't it more obvious?

There's a couple of things going on here. Short answer: The case that's making headlines this week isn't new, and it comes with a whole bunch of caveats.

The cured man in question is Timothy Ray Brown, also known as "The Berlin Patient". Back in 2007, Brown had a serious relapse of acute myeloid leukemia. To treat him, doctors had to kill off Brown's blood cells with chemotherapy, and then replace them with healthy donor cells via a bone marrow transplant. That's just standard leukemia treatment. In Brown's case, though, the doctors decided to get a bit creative, and chose a bone marrow donor who possessed a rare genetic mutation that makes a very small percentage of humans resistant to HIV infection.

We've talked about AIDS non-progressors here before—people whose bodies just naturally fend off HIV. Despite exposure, they never end up with high viral loads and, thus, don't ever really get sick. In fact, some of them can keep HIV at bay so successfully that they appear to have no viral load at all. The person who donated bone marrow to Timothy Ray Brown had the genetic mutation that creates non-progressors. And, thanks to the donation, he or she seems to have passed that talent on to Brown.

The case was already well-known. In fact, the real media firestorm surrounding the Berlin Patient happened in 2008, when Brown's doctors published their first account of the apparent cure. The recent news is based on soon-to-be published follow-up that's basically saying, "Yup. Here we are, almost four years later, and it still looks like Brown is HIV free."

Of course, sometimes, it can look like a person is virus-free, but then, if they go off of their medications, the HIV can suddenly reappear. Part of why this new paper is significant is that is presents evidence that the mutated cells are replacing Brown's original cells in parts of the body where HIV is known to hide out—suggesting that, if he does have hidden virus reservoirs, they're taking a beating, too.

That's interesting, but there's really not a whole lot going on here that wasn't already reported in 2008—or in 2009, when an earlier follow-up was published. That's a big part of why you aren't seeing a veritable ticker-tape parade today.

The other reason for the reserved reaction: Brown's cure isn't especially transferable. Remember, he already had leukemia, so the chemotherapy and bone marrow transplant were, for him, a reasonable risk. But that's not true for everybody with AIDS. The chemo-and-transplant combo is actually something you're kind of lucky to survive, in and of itself. For people who are successfully managing HIV with anti-retroviral drugs, this is sort of like saying, "We have a way to prevent you from ever dying in a car accident. But first, we have to drop you off of the top of this three-story building." It's not really worth it.

Other researchers say it's not even clear that this avenue could lead to a safer method of curing AIDS patients, in which case, it's not so much a "cure" as an interesting bit of research.

What's more, this treatment is also incredibly expensive. Bear in mind, the majority of AIDS patients are poor people who live in Africa, far from the kind of medical infrastructure available to Brown in Europe. This isn't going to do much for them.

Bottom line, Timothy Ray Brown has been cured of AIDS—but AIDS hasn't been cured.

Thanks to RandomToon and Maiku81 for Submitterating!

Image courtesy Flickr user TimoStudios via CC