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Timothy Ray Brown, known as the Berlin Patient, is thought to be the first patient ever to be cured of HIV infection.

Brown, 45, had two bone marrow transplants in Berlin in 2007 and 2008 to treat leukemia that is apparently unrelated to his HIV infection. The blood cells for the transplants came from a donor with a genetic mutation that makes his cells immune to HIV — they lack receptors the virus needs to gain entry to cells.

The transplants appear to have snuffed out Brown’s HIV infection. After an initial spike, the virus disappeared from his system — even though he is no longer taking anti-HIV drugs.

But new data presented last week in Spain raise a question about whether there are minute traces of HIV in some tissues — not whole virus capable of replicating, but pieces of viral genes.

Researchers have combed through 9 billion of Brown’s cells, retrieved from his blood, lymph nodes, spinal fluid and intestinal tract. Four different labs could find no trace of HIV in his blood cells. But three groups, using tests at the very limit of detectability, think they have identified bits of HIV genetic material — two from blood plasma and one from intestinal cells.

It could be a false reading, due to laboratory contamination, scientists say. For one thing, the fragments of viral genes don’t completely match those of the HIV Brown harbored before his transplants.

But AIDS researchers stress that even if the new findings constitute real evidence of HIV in his system, they don’t mean he’s not cured.

Although, it’s clear the findings do raise questions about what sort of cure he has.

Scientists hoped Brown had a so-called sterilizing cure — that is, the HIV has been completely eradicated from every cell in his body.

But long and bitter experience with HIV has shown that the virus can hide out in the genes of very long-lived resting immune cells. As these latently infected cells get activated over the years, HIV might reappear in the form of the whole virus or perhaps pieces of its genes.

But if that is happening in Brown, there is no evidence that the virus is actively replicating. To do that, it would need to infect other cells and hijack their genetic machinery to crank out more virus. Since Brown’s replacement immune system (from the bone marrow donor) doesn’t have the entry portal HIV needs, these new viruses (if they exist in his case) can’t spark a new viral conflagration.

Therefore, he may be functionally cured, even if he’s not totally free of HIV.

That’s what Brown himself thinks may be going on, from his discussions with researchers who have been poking and prodding him for the past five years.

“With a sterilizing cure, they have to be sure that a patient is completely clear of HIV — that they’ve looked everywhere and can’t find any,” Brown says. “In my case, I still have the dead virus and it’s still showing up in some ways, and so I’ve got a functional cure.”

To him, that’s just as good.

Brown is particularly upset at suggestions that he has become reinfected with HIV through unsafe sex. “That is not the case,” he says. “It’s very difficult for me to listen to those things and read those things.”

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Doctors Say Stem Cell Treatment Eradicates HIV in Berlin Patient

Timothy Brown, a US expat living in Berlin, is said to have been cured of HIV infection via genetically-engineered stem cells, according to reports from doctors, writes AIDSMAP:

Doctors who carried out a stem cell transplant on an HIV-infected man with leukaemia in 2007 say they now believe the man to have been cured of HIV infection as a result of the treatment, which introduced stem cells which happened to be resistant to HIV infection.

The man received bone marrow from a donor who had natural resistance to HIV infection; this was due to a genetic profile which led to the CCR5 co-receptor being absent from his cells. The most common variety of HIV uses CCR5 as its ‘docking station’, attaching to it in order to enter and infect CD4 cells, and people with this mutation are almost completely protected against infection.

The case was first reported at the 2008 Conference on Retroviruses and Opportunistic Infections in Boston, and Berlin doctors subsequently published a detailed case history in the New England Journal of Medicine in February 2009.

They have now published a follow-up report in the journal Blood, arguing that based on the results of extensive tests, “It is reasonable to conclude that cure of HIV infection has been achieved in this patient.”

Brown, who is referred to as ‘The Berlin Patient’ gave an interview to German magazine Stern:

His course of treatment for leukaemia was gruelling and lengthy. Brown suffered two relapses and underwent two stem cell transplants, as well as a serious neurological disorder that flared up when he seemed to be on the road to recovery.

The neurological problem led to temporary blindness and memory problems. Brown is still undergoing physiotherapy to help restore his coordination and gait, as well as speech therapy.

Friends have noticed a personality change too: he is much more blunt, possibly a disinhibition that is related to the neurological problems.

On being asked if it would have been better to live with HIV than to have beaten it in this way he says “Perhaps. Perhaps it would have been better, but I don’t ask those sorts of questions anymore.”

Brown’s case is obviously one of very specific traits where similar treatment would be unlikely to benefit people with HIV in other situations. More on Brown’s case history at AIDSMAP.

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