American citizen Timothy Ray Brown, who has been off antiretrovirals (ARVs) for years, came to UCT on Monday September 11 to tell his story.
Mr Brown is cured of HIV after living with the virus for several years. He was somewhat cured by default while taking measures to combat the leukaemia he was fighting.
In 1995 Mr Brown was diagnosed with HIV while living in Berlin and was put on ARV. Then, in 2006, he discovered he had leukaemia and was told her needed a bone marrow transplant.
In 2007, Mr Brown underwent a procedure known as hematopoietic stem cell transplantation performed by a team of doctors in Berlin. From 60 matching donors, they selected a donor who had the “delta 32” mutation on the CCR5 receptor. This genetic trait confers resistance to HIV infection by blocking attachment of HIV to the cell. After the bone marrow transplant, Mr Brown was cured of cancer and HIV because the transplanted cells replaced his damaged and diseased cells with the healthy donor cells.
This method has been tried in other HIV-positive patients, but it hasn’t worked. “Initially I didn’t want to do the transplant,” he said. “I was undergoing chemotherapy, and they said that the transplant was 50% effective, but there was a 50% chance that you could die. I was in remission and said that I wouldn’t do it unless the leukaemia comes back.
“It came back, and, in 2007, I ended up getting the transplant. I quit taking ARVs and have never taken it since. My viral load dropped to undetectable without ARVs. The doctor did a colonoscopy to see if I have HIV in my colon and I didn’t,” said Mr Brown.
The new cells killed off the old cells and populated the immune system with resistant cells.
Mr Brown’s case sparked the idea for cure research and has inspired hope to find a cure that involves very early treatment or treatment taken every once in awhile rather than daily ARVs.
Wendy Burgers, who works in the virology division at UCT’s department of pathology, said there were many ways that HIV persisted in patients taking ARVs, but figuring out how to get rid of it completely to the point of no return was what was being investigated.
HIV replicates in cells, so HIV patients on ARVs may see their viral loads drop but they shoot up again quickly if they come off the drugs.
One possible cure being tested is the “shock and kill method, which uses a drug to “wake up” the virus in dormant cells and then kills those cells with latency reversing agents (LRAs) so they can’t replicate. The problem with this is that the LRAs target all cells and might damage the immune system.
Then there is the “lock and block” method, which involves ensuring that HIV cells in deep latency never “wake up”.
Mr Brown said he felt survivor’s guilt being the only person to be cured of HIV, but he hopes his story can inspire hope in others.
“It is a burden, in a sense, I don’t think I could sleep at night if I am not doing what I’m doing. I try to get my message out there. I’m glad that I can give people hope.”