For just the second time since global AIDS epidemic began, HIV has been eliminated from a patient’s body. Is a cure for the deadly virus in sight?
Twelve years ago, a patient named Timothy Ray Brown was cured of HIV. Scientists have been trying since then to replicate the cure, but they have been unsuccessful until now. On today’s episode, we’ll talk about the London Patient, the second person in the world to have seen off HIV.
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Second patient cured of HIV
A patient in London appears to have been cured of HIV, the virus that causes AIDS. If true, he would be just the second person in history to have been cured since the global epidemic emerged in 1981. The first case of a man cured of HIV was 12 years ago and scientists have been trying to replicate the cure since then. They have been unsuccessful, until now.
A group of scientists published a paper last week in the medical journal Nature describing what happened. Officially, they are not calling it a cure; instead, they are saying it’s a long-term remission, meaning that the virus has not appeared in a long time. Still, it would be a breakthrough in the fight against AIDS, a disease that has caused the deaths of almost 40 million people in less than 40 years.
Let’s take a step back. HIV is the human immunodeficiency virus; it is the virus that causes AIDS. When fully developed, AIDS attacks specific parts of your immune system that make it difficult for you to fight off routine infections. If you have the disease, your body cannot fight off common bacteria that cause no harm to others. People who die from having AIDS typically die from having been infected over and over with common bacteria and viruses. About half the people who develop AIDS die from it. Many of them are in Africa; in some African countries, over 15 percent of the adult population is infected with HIV.
There is no cure for AIDS and no reliable way to kill the HIV virus, even with the latest news. However, people diagnosed with HIV no longer face a death sentence like they did in the 1980s and 1990s. Advances in anti-retroviral drugs mean that people infected with HIV can live long, healthy lives; never pass along HIV to their partners; and never develop AIDS, as long as they can afford their medication, which many people in the west now can. Still, a cure would be welcome.
That brings us to last week’s news. The patient, who is being called the London Patient because he prefers anonymity, had both HIV and blood cancer. The treatment for his blood cancer was a bone marrow transplant. Bone marrow is the soft tissue inside your bones, and this is the part of your body that generates new blood cells. Plenty of people with HIV have gotten bone marrow transplants over the years and have continued to have HIV. But this case was different.
In this case, the patient’s doctors suggested that he use a bone marrow donor with a special type of genetic mutation, which is to say they chose a donor that had a variation in his or her genes that most people do not have. This mutation actually changes certain parts of the cells in your immune system. Specifically, there is a protein in your immune cells called CCR5. The HIV virus uses this CCR5 protein to get into the immune system cells. All viruses need to get into a host cell; without being able to get into the immune cells, HIV would not replicate itself. But here’s the key: HIV cannot get into a host cell in people who have this genetic mutation. That’s why people with this mutation don’t get HIV in the first place. And when they donate their bone marrow to an HIV-positive patient, the patient’s immune system gradually clears itself of HIV because the newly generated cells don’t let the virus take hold.
Remember that your bone marrow is where you produce new blood cells. As the patient’s brand-new bone marrow starts producing more cells, those cells are immune to the HIV virus. Because cells are dying and being replaced all the time, the patient’s immune system is eventually comprised only of cells made by his new bone marrow, and none of his immune system would be affected by HIV. That is what scientists discovered, and that his how both the first patient twelve years ago and the second patient most recently have been cured of HIV.
A bone marrow transplant, however, is not a practical treatment for the average person that is HIV positive. For one thing, only about one in a thousand people of European descent has this particular mutation; it’s even rarer among other populations. So there are not a lot of people who can be the donors. What’s more, a bone marrow transplant is risky in and of itself. It is a rigorous, draining, and risky procedure that you would not want to do unless you absolutely needed it. In order to have this transplant, you have to actually kill your existing bone marrow. Because it’s so dangerous, doctors would not be willing or able to do bone marrow transplants to cure patients of HIV. In a way, the so-called cure would be worse than the disease. There is one other caveat. Not all HIV viruses are the same; in fact, another strain of HIV actually doesn’t enter the immune system via CCR5, but via another protein called CXCR4.
Still, this is a missing piece of the puzzle. With this, scientists at least know how two people have been cured of HIV. They can now focus research on finding gene therapies that can cause this CCR5 mutation in people who were not born with it.
The first patient to be cured is named Timothy Ray Brown. He was happy to hear the news of a second patient cured. Here’s what he said about it. He said, “If something has happened once in medical science, it can happen again. I’ve been waiting for company for a long time.”
I want to say thank you to a few people in the audience who took a look at the text of this episode before I recorded it. It’s well documented by now that I’m no expert at science, so I asked some of my WhatsApp contacts if anyone knew about genetics and such. And I got a few volunteers to read the text and make sure that I got my facts right. So I want to say thank you to Gui, Boris, Andrea and Flaviana for taking a look. And I was telling a few people on WhatsApp that I got some volunteers to help me. And here’s what Luciana from Brazil said when she heard that people were helping me out. She told me that Plain English has the best audience in the world. And that is just spot on. All I had to do was say I needed some help from people who know about genetics, and here I get scientists, doctors, engineers all volunteering to help. You guys really are the best audience in the world, Luciana is exactly right.
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