Farewell to False Hope? Would-Be HIV Cure Stumbles

We were warned. Treating HIV via bone marrow transplant was risky, excruciating, and, above all, hardly guaranteed to work. Basically, if a patient didn't need the treatment anyway to fight leukemia or lymphoma, it was a nonstarter cure. Nonetheless, after Timothy Ray Brown, aka "the Berlin patient," came out the other end of the procedure testing negative for HIV, it became the disease's biggest news since the development of the lifesaving drug regimine known as highly active antiretroviral therapy (HAART) in the '90s. There was other positive news, perhaps with more real-world promise—neutralization via antibodies, first-ever HIV vaccine Truvada, post-exposure infection prevention—but Brown was and remains hope's cover star.

Timothy Brown remains free from infection five years after being declared "cured." Last summer, it looked promising for two more patients, both undergoing similar marrow transplants as part of a study in Boston. By July, one patient had been HIV-free for 15 weeks and the other, seven weeks. A third patient was dead. (The procedure that "cured" Brown is considered risky enough to be unethical in patients not in imminent danger of death.) Now, a half a year later, HIV has returned in both of the surviving patients.

Dr. Timothy J. Henrich, the doctor overseeing the patients, noted in a statement that after returning to HAART therapy, "the virus is now suppressing as expected and they are both currently in good health." Just the existence of HAART should still be taken as miraculous really, compared to the nightmare of the disease's first two decades of wholesale devastation. A few years ago, I made the point that we live in a post-cure world now and it's worth returning to that idea with two patients once again positive and  third, yes, dead.

HIV is the disease that makes curing something into an ideology. We know now, after 30 years with the illness, that it is supernaturally good at resisting cure. A large part of this talent is in HIV's ability to hide. It's possible now to beat back the virus to the point that it goes totally undetectable in the body. Once beaten back this far, the only way to bring HIV back to the surface is to stop treating it. Discontinue HAART and the virus, after a month or so, begins to multiply and reappear again. It's a feature that turns curing the disease into a rhetorical exercise as well as a medical one. HIV has beaten medicine at its own definitions, and it's no wonder we're at the point of suicide therapy in fighting it.

HIV has "won" by making itself too much a part of ourselves to get rid of without taking extremely self-destructive action. I honestly don't know what that means, but it's something fundamental in medicine and worth keeping in mind as the slog continues. Timothy Brown wasn't cured of anything; he had his immune system removed and regenerated. That's a big something else with the convenient side effect of eliminating HIV from the body.

@everydayelk

the virus is now suppressing as expected and they are both currently in good health. Read more at: http://www.firstpost.com/fwire/hiv-virus-returns-in-two-cured-patients-us-doctor-1273175.html?utm_source=fwire&utm_medium=hp

the virus is now suppressing as expected and they are both currently in good health. Read more at: http://www.firstpost.com/fwire/hiv-virus-returns-in-two-cured-patients-us-doctor-1273175.html?utm_source=fwire&utm_medium=hp