1 man's success revives hope of curing AIDS, 30 years after first cases appeared

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1 man's success revives hope of curing AIDS, 30 years after first cases appeared

in the US

By Marilynn Marchione, The Associated Press | The Canadian Press – Fri, 3 Jun,

2011

..Sunday marks 30 years since the first AIDS cases were reported in the United

States. And this anniversary brings fresh hope for something many had come to

think was impossible: finding a cure.

The example is Ray Brown of San Francisco, the first person in the world

apparently cured of AIDS. His treatment isn't practical for wide use, but there

are encouraging signs that other approaches might someday lead to a cure, or at

least allow some people to control HIV without needing medication every day.

" I want to pull out all the stops to go for it, " though cure is still a very

difficult goal, said Dr. Fauci, director of the National Institute of

Allergy and Infectious Diseases.

For now, the focus remains on preventing new infections. With recent progress on

novel ways to do that and a partially effective vaccine, " we're starting to get

the feel that we can really get our arms around this pandemic, " Fauci said.

Nearly 30 million people have died of AIDS since the first five cases were

recognized in Los Angeles in 1981.

About 34 million people have HIV now, including more than 1 million in the

United States.

About 2 million people die of the disease each year, mostly in poor countries

that lack treatment. In the U.S. though, newly diagnosed patients have a life

expectancy only a few months shorter than people without HIV. Modern drugs are

much easier to take, and many patients get by on a single pill a day.

But it wasn't that way in 1995, when Brown, an American working as a translator

in Berlin, learned he had HIV. He went on and off medicines because of side

effects but was holding his own until 2006, when he was diagnosed with leukemia,

a problem unrelated to HIV. Chemotherapy left him so sick he had to be put into

a coma to allow his body to recover.

" They didn't know if I'd survive that, " Brown said.

Dr. Gero Huetter, a blood cancer expert at the University of Berlin, knew that a

transplant of blood stem cells (doctors used to use bone marrow) was the best

hope for curing Brown's cancer. But he aimed even higher.

" I remembered something I had read in a 1996 report from a study of people who

were exposed to HIV but didn't get infected, " Huetter said.

These people had gene mutations that provide natural resistance to the virus.

About 1 per cent of whites have them, and Huetter proposed searching for a

person who also was a tissue match for Brown.

But transplants are grueling. Huetter would have to destroy Brown's diseased

immune system with chemo and radiation, then transplant the donor's cells and

hope they would take hold and grow. Many cancer patients die from such attempts

and Brown wasn't willing to risk it.

His mother, Sharon Brown of Seattle, agreed.

" Before I knew he had HIV I used to have nightmares about it, " and gambling on a

transplant to try to cure it didn't seem smart when the cancer seemed to be in

remission, she said.

Several months later, the return of leukemia changed their minds.

Brown discussed the transplant with his boss " and she said, 'wow, this is

amazing. Because you have leukemia, you could be cured of HIV.' "

A registry turned up more than 200 possible donors and Huetter started testing

them for the HIV resistance gene. He hit pay dirt at No. 61 — a German man

living in the United States, around 25 years old.

Brown had the transplant in February 2007. A year later, his leukemia returned

but HIV did not. He had a second transplant in March 2008 from the same donor.

Now 45, Brown needs no medicines, and his only health problems are from the

mugging he suffered two years ago as he returned home one night in Berlin. Brown

was knocked unconscious, required brain surgery and therapy to walk and talk

again, and doesn't have full use of one arm. He moved back to the United States

in December.

" He's now four years off his antiretroviral therapy and we have no evidence of

HIV in any tissue or blood that we have tested, " even places where the virus can

lie dormant for many years, Huetter said.

Brown's success inspired scientists to try a similar but less harsh tactic:

modifying some of a patient's infection-fighting blood cells to contain the

mutation and resist HIV. In theory, this would strengthen the immune system

enough that people would no longer need to take HIV drugs to keep the virus

suppressed.

Scientists recently tried this gene therapy in a couple dozen patients,

including Sharp of suburban San Francisco. More than six months later,

the number of his infection-fighting blood cells is " still significantly higher

than baseline, " he said.

It will take more time to know if gene therapy works and is safe. Experiments on

dozens of patients are under way, including some where patients go off their HIV

medicines and doctors watch to see if the modified cells control the virus.

The results so far on the cell counts " are all wonderful findings but they could

all amount to nothing " unless HIV stays suppressed, said Dr. Lalezari,

director of Quest Clinical Research in San Francisco who is leading one of the

studies.

The approach also is not practical for poor countries.

" I wouldn't want people to think that gene therapy is going to be something you

can do on 33 million people, " said Fauci.

Other promising approaches to a cure try new ways to attack the dormant virus

problem, he said. They hinge on getting people tested and into care as soon as

they become infected.

Fauci's institute has boosted money for cure research, and the International

AIDS Society, a professional organization for those who work in the field, has

added finding a cure to its strategic plan.

" There are paths forward now " to a day when people with AIDS might be cured,

said Dr. Horberg, a member of President Obama's HIV/AIDS council and

vice chairman of the HIV Medicine Association, doctors who treat the disease.

" But it's not tomorrow, and it's not today. "