Opinion – Esper Kallás: What the fourth case of the patient who was cured of HIV/AIDS tells us


People diagnosed with HIV/AIDS are advised to start their treatment by taking specific drugs, the so-called “cocktail”. These are medicines that control the multiplication of the virus and allow normal life to be preserved, allowing the maintenance of physical integrity, family and children planning.

But there is always the question, which is frequent in medical consultations: when will the cure come? Although it is said that the infection has an excellent control for those who follow medical care and take medication regularly, the threat of prejudice, discrimination and stigma persists. In addition to the need for permanent use of the medicines, without a deadline to stop, which can bring some side effects.

Will we have a cure? It exists and was initially documented in the “Berlin patient”. Timothy Ray Brown revealed to the world that he was the first patient to be cured, after discovering leukemia and undergoing treatment with two bone marrow transplants in Germany.

He spent many years volunteering for tests and spreading the idea that a cure is possible until, unfortunately, the leukemia came back and took his life, in September 2020. He even visited São Paulo, where he engaged students and researchers in the cause of cure, with interviews and debates with the press.

After Timothy was cured, three other similar cases occurred. Two adults and a child who were living with HIV were found to have a serious hematological disease, which required hematopoietic stem cell transplantation, popularly known as bone marrow transplantation.

The most recent case of a cure was announced during the World AIDS Congress, which is taking place in Montreal, Canada. This is a 26-year-old man who was living with HIV and was diagnosed with leukemia. 26 weeks after the bone marrow transplant, even though he stopped using the cocktail drugs, HIV was no longer found in his blood.

In all four cases there is something in common. Donors of material for transplantation have a mutation known as CCR5delta32. With it, defense cells do not have one of the essential receptors for HIV to bind, establishing a barrier to viral multiplication.

The initial case of the “Berlin patient” is no longer just a coincidence. With four cases, the cure becomes a possible concept. But there is no way to do a bone marrow transplant on everyone who has the virus.

Bone marrow transplantation is one of the most radical interventions in medicine. Basically, the entire production system of the patient’s blood elements is exchanged for that of the donor. With this, an attempt is made to eliminate cancer cells that have given rise, for example, to leukemia. For this procedure, it is necessary for hematologists to also “turn off” the patient’s entire defense system when replacing it with a new one.

In this way, transplant recipients temporarily lose their ability to react to germs, becoming subject to serious infections. Other complications involve reactions against some organs and tissues, as a result of the radical change in your immune system. Still, 10% to 20% of patients may die in the first year after transplantation.

For all these reasons, there is no way to generalize the indication of bone marrow transplantation for all people living with the virus. These cited are still isolated cases, which fulfill a series of conditions.

However, with these cases, although rare, a path of investigation was definitely open. That Timothy’s effort was worth it.

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