A second person appears to have been cured of HIV infection — a result that researchers say confirms what many feared might be a one-time medical accident was, in fact, repeatable. The case, published in the journal Nature in March 2019 C.E., involves a man known only as the “London patient,” who received a bone-marrow transplant to treat Hodgkin’s lymphoma and has remained free of detectable virus for more than a year after stopping antiretroviral drugs.
At a glance
- HIV cure: The London patient stopped antiretroviral drugs in September 2017 C.E., making him the first person since Timothy Ray Brown — the “Berlin patient” — known to remain virus-free for more than a year after stopping treatment.
- Bone-marrow transplant: The procedure used donor cells carrying a mutation in the CCR5 protein, which HIV normally uses to enter immune cells; the mutated version blocks the virus from latching on.
- CCR5 mutation: Most people carrying this protective genetic variant, known as delta 32, are of Northern European descent; the IciStem consortium maintains a database of roughly 22,000 such potential donors.
The findings were presented at the Conference on Retroviruses and Opportunistic Infections in Seattle and published simultaneously in Nature. The lead researcher, Dr. Ravindra Gupta, a virologist at University College London, described the result as shifting how scientists understand what the procedure requires.
“I think this does change the game a little bit,” Gupta said. “Everybody believed after the Berlin patient that you needed to nearly die basically to cure HIV, but now maybe you don’t.”
Why the London patient matters
The first known cure — Timothy Ray Brown’s in 2007 C.E. — came at enormous physical cost. Brown had leukemia and required two bone-marrow transplants, harsh immunosuppressive drugs no longer in standard use, and a period in an induced coma. He nearly died. For years afterward, researchers tried and failed to replicate the result, and many wondered whether the extreme nature of his treatment was what had made it work.
The London patient answered that question directly. He received a single bone-marrow transplant in May 2016 C.E., with immunosuppressive treatment in line with current clinical standards — far less punishing than what Brown endured. The transplant cleared his cancer without significant side effects. And the transplanted immune cells, carrying the CCR5 mutation and therefore resistant to HIV, appear to have fully replaced his vulnerable cells.
Scientists from the IciStem consortium — a European research group supported by amfAR, the American AIDS research organization — have repeatedly tested the London patient’s blood. Of 24 tests, one showed a weak signal for the virus, but researchers say contamination of the sample may explain it. The most sensitive test found no circulating virus. Antibodies to HIV remain in his blood, but their levels have been declining over time, following a trajectory similar to Brown’s.
“In a way, the only person to compare with directly is the Berlin patient,” Gupta said. “That’s kind of the only standard we have at the moment.”
Scientists are calling it a cure — carefully
Publicly, the researchers describe the case as a “long-term remission.” In interviews, most experts called it a cure, while acknowledging the difficulty of applying that word when only two instances exist. Dr. Annemarie Wensing, a virologist at the University Medical Center Utrecht and co-leader of IciStem, put it plainly: “This will inspire people that cure is not a dream. It’s reachable.”
Others were more cautious about what the result means for the broader fight against HIV. Dr. Anthony Fauci, then director of the National Institute of Allergy and Infectious Diseases, acknowledged the case but pressed on its practical implications: “It was done with Timothy Ray Brown, and now here’s another case — ok, so now what? Now where do we go with it?”
The London patient himself, who chose to remain anonymous, described the experience as “surreal” and “overwhelming” in an email to The New York Times. “I never thought that there would be a cure during my lifetime,” he wrote.
Brown, now living in Palm Springs, California, welcomed the news. “If something has happened once in medical science, it can happen again,” he said. “I’ve been waiting for company for a long time.”
The path from transplant to treatment
Bone-marrow transplantation is not a near-term solution for the roughly 38 million people living with HIV worldwide. The procedure is expensive, risky, and only appropriate for patients who already need it to treat cancer. Effective antiretroviral drugs are available and far safer for most people. This result is one of many public health wins in the long effort to control and eliminate infectious disease, but translating it into a scalable treatment requires a different approach.
The most promising direction, several researchers said, is gene therapy. Scientists at multiple institutions are working to knock out CCR5 receptors on immune cells or their stem-cell precursors — effectively engineering HIV resistance without a transplant. The modification must be precise: targeting bone marrow, not the brain, and affecting only CCR5 production. Dr. Mike McCune, then a senior adviser at the Bill and Melinda Gates Foundation, described the eventual goal as a viral delivery system that, when injected, seeks out and deletes all CCR5 receptors. “These are dreams, right? Things on the drawing table,” he said. “These dreams are motivated by cases like this.”
There is an important limit. Targeting CCR5 only protects against the most common strain of HIV. A variant called X4 uses a different protein, CXCR4, to enter cells. Dr. Timothy J. Henrich, an AIDS specialist at the University of California, San Francisco, estimated that this approach would work for “about 50 percent of the people who are living with HIV, if not less.” At least one person who received a delta 32 transplant later rebounded with the X4 strain. As a precaution, Brown takes a daily pill to guard against it.
IciStem was tracking 38 HIV-positive people who had received bone-marrow transplants at the time of publication. One of them, referred to as the “Düsseldorf patient,” had been off antiretroviral drugs for four months. The London patient is number 36 on that list. The science is moving — slowly, carefully, and with honest uncertainty about how far these early results will carry.
Read more
For more on this story, see: The New York Times
For more from Good News for Humankind, see:
- Japan launches world-first Parkinson’s stem cell treatment trial
- UK researchers find a drug that could treat primary bone cancer
- The Good News for Humankind archive on global health
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