In the past week, the second and third man living with HIV have reportedly been cured. “Cured,” perhaps, isn’t the right word, since the virus could potentially resurface, which is why some health professionals are instead opting for the phrase “long-term remission.”
The second and third cases of long-term remission occurred in the “London patient” and “Dusseldorf patient,” both of whom wish to remain anonymous at this time.
The news comes a dozen years after the “Berlin patient,” later identified as Timothy Ray Brown, who was also “cured” of the virus under similar circumstances. All three men received a bone marrow transplant from a donor with a mutation in the CCR5 protein. The mutation inhibits HIV from invading white blood cells. Only 1% of people descended from Northern Europeans, particularly those from Sweden, have the rare mutation.
Notably, in all three patients, the transplants were a last resort intended to treat cancer, not HIV.
While news of the recent milestones is exciting, it’s unclear exactly what the implications are for researchers and people currently living with HIV.
“I try to absorb and process these kinds of medical ‘breakthroughs’ with careful trepidation,” Louie Ortiz-Fonseca, director of LGBTQ health and rights, and founder of ECHO (Engaging Communities Around HIV Organizing) at Advocates for Youth, tells NewNowNext.
“We’ve always heard we’re on the brink of a cure. What does that do for the psyche of people living with HIV? Sometimes, it feels like there’s this carrot that we’re chasing, but will never be able to touch. While it does provide a kind of hope, it doesn’t necessarily mean that what we are experiencing or dealing with on a daily basis changes.”
Stem cell or a modified bone marrow transplant “is not a remotely plausible strategy for HIV treatment,” claims Kenneth Freedberg, MD. Freedberg is a professor of medicine at Harvard Medical School and Massachusetts General Hospital, as well as the director of the program in epidemiology and outcomes research at the Harvard University Center for AIDS Research.
“A bone marrow transplant is an extraordinarily toxic and life-threatening intervention, which you do if someone has an illness that’s clearly going to be fatal. There must be no other treatment options available. It puts people at massive risk for infections and toxicity complications,” explains Freedberg.
Several patients have in fact died during similar procedures. “We’re not two for two with this,” he adds.
In addition to the risks, donors must be a genetic match to recipients, and then must be one of the 1% of Northern Europeans who have a mutated CCR5. IciStem, a consortium of European scientists studying stem cell transplants to treat HIV infection, maintains a database of only 22,000 such donors.
That’s why Josh Robbins, an award-winning HIV sexual health advocate and spokesperson for DatingPositives, tells NewNowNext, “I’m much more excited about the news that undetectable equals untransmittable.”
Robbins is referencing the CDC’s statement from October 2017, when the federal agency proclaimed that people with HIV who have an undetectable viral load are incapable of passing on the virus to partners sexually, even without a condom. This is often abbreviated as “Undetectable = Untransmittable” or “U = U.”
“The London [or Dusseldorf] patient’s story doesn’t mean a whole lot to anyone else living with HIV. The U equals U news is important to anyone that has sex,” he continues.
Besides, Robbins, who’s positive himself, already feels healthy and is in long-term remission as a result of taking his antiretroviral medications daily.
“I’m certainly not going to put my life at risk to try to get cured,” he says.
Dr. Freedberg agrees with Robbins. Freedberg notes that there are multiple options for medications, so there’s virtually always a way to find a medication or combo of medications that will help someone maintain an undetectable viral load without any side effects.
“The contrast between the available therapy—which is superb, safe, and well-tolerated—and something like a bone marrow transplant is just extraordinarily different.”
While stem cell transplants aren’t a feasible option to end the HIV epidemic, Freedberg believes “we already have the tools now to really end the epidemic in the United States, and the first step is testing.”
Freedberg explains that testing will inform those who are positive, and they can then get treatment to keep their viral load undetectable. Those who are negative can go on PrEP if they’re high-risk or can continue wearing condoms if they’re not high-risk.
“I truly believe we can end the epidemic and it’s not going to be with a cure strategy via stem cells,” he says. “It’s going to be through testing, treatment, and prevention, all of which we can do starting tomorrow.”