Timothy Ray Brown, the Berlin Patient, Accepts Award
At an HIV cure symposium held in January at the University of California, San Francisco, the man formerly known as the “Berlin Patient,” Timothy Ray Brown, accepted an award for his heroic contributions to HIV research. He is the only person known to be cured of HIV, and has over the years undergone extensive testing so that researchers can better understand how and why he was cured.
Accepting the award, Brown said, “I want to accept this award on behalf of the millions of people who are infected with HIV, those who have died of the disease, and also the patients who have made an effort in trying to help find a cure.”
Steven Deeks, MD, a Professor of Medicine in Residence at UCSF presented the award, and described what it was like to see Brown at his clinic in 2011 after Brown moved to San Francisco.
“There were lots of issues to deal with that I didn’t know how to handle,” Deeks joked. “In all the paperwork in an HIV clinic, you have to basically say whether the patient is HIV positive or negative. I never could quite figure out how to answer that question.”
“I asked him to come in for a blood draw, and he said yes,” Deeks continued. “Then I said, we need a lot of blood, how about leukapheresis, and he said yes. Then I said, we really don’t think the virus is in your blood, we think it’s in your gut, how about a rectal biopsy, and he said yes. Then we told him we don’t really think it’s in your rectum, we think it’s in your ileum, about 20 feet up in your gut, and he said yes. Then we thought maybe it’s in your brain, and he had a lumbar puncture. Then we said, we can’t find it anywhere else, how about a lymph node biopsy, and he said yes. And he never complained.”
In 2006, Brown, who was then on antiretrovirals (ART) with good viral suppression, developed leukemia and underwent two bone marrow transplants after other treatment failed. Brown’s doctor, Gero Hütter, MD, had the idea to use bone marrow from a donor with a double CCR5-delta-32 mutation. This means that the stem cells were missing the CCR5 coreceptor that most types of HIV use to enter T-cells. Brown underwent intensive chemotherapy that killed off his cancerous immune cells, and his immune system was rebuilt from the donor’s stem cells.
Although Brown stopped ART when he received the chemotherapy and bone marrow transplants, his HIV did not return. Despite seven years of poking and prodding, researchers have not been able to detect replication-competent HIV in his blood plasma, peripheral blood cells, or anywhere else they have looked.
It remains unclear whether Brown’s cure is due to using stem cells missing CCR5, the intensive chemotherapy, a graft-versus-host reaction (in which the donor cells attack the recipient’s body), or some other unknown factors. However, Hütter recently reported that six other HIV-positive cancer patients have undergone bone marrow transplants from CCR5-delta-32 donors, and none have experienced a cure like Brown’s (five died from cancer progression or complications, while one experienced rebound with HIV that uses the alternate CXCR4 coreceptor).
Many speakers attending the UCSF symposium noted that Brown’s unique case had helped inspire their careers dedicated to finding an HIV cure.
Liz Highleyman is a freelance medical writer and editor-in-chief of HIVandHepatitis.com.