When the highly effective combination antiretroviral treatment for HIV arrived in 1996, Dr. David Ho, who was one of the architects of this therapeutic revolution and is the director of the Aaron Diamond AIDS Research Center in New York City, famously theorized that given enough time, such medications could eventually eradicate the virus from the body. To date, there are a handful of cases of people who were started on antiretroviral very soon after contracting HIV, later went off treatment and have remained in viral remission with no rebounding virus for years.
Otherwise, Ho’s prediction has proved false. During the past quarter-century, HIV-cure researchers have learned in increasingly exacting detail what a daunting task it is not only to cure HIV, but to develop effective curative therapies that are safe and scalable.
HIV maintains such a permanent presence in the body because shortly after infection, the virus splices its genetic code into long-lived immune cells that will enter a resting state — meaning they stop churning out new viral copies. Antiretroviral only work on replicating cells, so HIV can remain under the radar of such medications in resting cells for extended periods, sometimes years. Absent any HIV treatment, such cells may restart their engines at any time and repopulate the body with massive amounts of virus.
Timothy Brown’s case, published in 2009, ignited the HIV-cure research field, which has seen soaring financial investment since.
In 2019, researchers announced two new cases of HIV remission following treatments that mirrored what Brown received. These included London resident Adam Castillo, who had Hodgkin lymphoma, and a man in Düsseldorf, Germany, who had AML.
More than three years have passed since these two men have been off of HIV treatment, with no viral rebound. Consequently, the authors of each of their case studies — University of Cambridge’s Ravindra K. Gupta and Dr. Bjorn Jensen of Düsseldorf University Hospital — each recently told NBC News their respective patient was “almost definitely” cured of the virus.
Since 2020, scientists have also announced the cases of two women whose own immune systems have apparently cured them of HIV. They are among the approximately 1 in 200 people with HIV known as “elite controllers,” whose immune systems can greatly suppress viral replication without medication. In their cases, their bodies went even further and apparently destroyed all functional virus.
A less toxic treatment ;
- Another major upside of the haploid transplant the New York patient received, compared to the treatment of her three male predecessors, is that the use of cord blood — for not entirely understood reasons — greatly reduces the risk of what’s known as graft vs. host disease. This is a potentially devastating inflammatory reaction in which the donor cells go to war with the recipient’s body. The men in the three other HIV-cure cases all experienced this, which in Brown’s case caused prolonged health problems. Brown died at 54 in September 2020 from recurrent leukemia.
The New York patient was the second person with HIV to receive a haploid transplant in hopes of curing the virus. However, the first person died of his cancer soon after his 2013 treatment.
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