walkitout (walkitout) wrote,
walkitout
walkitout

The Improbability of Timothy Brown

http://nymag.com/health/features/aids-cure-2011-6/

This is a great story -- a long one -- full of possibilities. A man who had HIV under control with retrovirals developed leukemia. The doctor who treated him picked a stem cell donor who had a natural genetic mutation that is very, very resistant to HIV. It took two rounds of treatment, but ultimately Brown was cured of both HIV and leukemia. Then it took even longer for there to be consensus that it was an effective cure.

It is expensive (altho less expensive that you might imagine -- if first line retrovirals don't work for you, the math looks good to me for going this round) and depending on which part of the leukemia treatment is the part that matters in terms of curing the HIV, possibly really amazingly awful. However, the approach does offer the tantalizing prospect of alternative strategies that might be cheaper, less painful and as effective.

The story is a political one. When retrovirals first came out and were shown to drop viral load in the blood so completely, it was believed by some that they constituted a cure. Yet they do not. In the wake of that drastic disappointment, opposition to the idea of a cure developed and that opposition is having to be eroded. There are also very real economic disincentives to developing a cure (pharma loves chronic and HIV is Chronic. A cure is NOT chronic.).

I recently read _Magic Slays_ by Ilona Andrews and I harbor a suspicion that the writing team responsible for that series is aware of this story. In this most recent entry, Our Heroine uses her blood magic to "cleanse" the Lyc-V infected blood of her ward. It's a difficult and dangerous and novel procedure that involves infecting Julie with the vampire virus as well. The effect at the end of the procedure is a Julie cured of Lyc-V, which no vampire virus to be found in her blood. I read that novel first (a couple days ago? I don't think I've posted a review yet) and only just stumbled across the HIV cure. But the parallel is quite clear. Very strange! And yet reality is stranger still.

ETA: I'm a little puzzled by the unbelievably limited coverage of Timothy Brown/"The Berlin Patient". As near as I could tell from the above link to New York Magazine, Brown's treatment for leukemia was _really standard_, with the exception of testing on donor matches to prefer ones with the right mutation. According to this (dug out of a wikipedia article on AIDS):

http://online.wsj.com/article/SB122602394113507555.html

"In 1989, Dr. Rossi had a case eerily similar to the one in Berlin. A 41-year-old patient with AIDS and lymphoma underwent radiation and drug therapy to ablate his bone marrow and received new cells from a donor. It is not known if those cells had the protective CCR5 mutation, because its relation to HIV hadn't been discovered yet. But after the transplant, HIV disappeared from the patient's blood. The patient died of his cancer 47 days after the procedure. Autopsy tests from eight organs and the tumor revealed no HIV."

Obviously, if you can avoid treatment for leukemia, you want to. Equally, "cure" has a bad rep in the HIV community, and "gene therapy" has a bad rep for a variety of reasons as well. That plus the pharma-loves-chronic MAY add up to an explanation for why this approach is taking a while to get off the ground -- but it doesn't feel like enough. I think the real problem has to do with the way innovation happens and how it spreads. And this is one of those times where the path to a "thought leader" from where the innovation originated has too many wide gaps.
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