Searching for HIV in Timothy Brown, the Berlin Patient

Last year, Steven Yukl from UCSF presented the results of an exhaustive search for HIV genetic material in Timothy Brown (aka the Berlin Patient) – the one adult individual considered cured of the infection. [1]

The study engendered controversy, because a few of the multiple independent laboratories that participated did obtain positive readings for trace amounts of HIV RNA and DNA in some blood and tissue samples (the vast majority of the tests, including those looking for replication-competent virus in large volumes of cells, were negative). One scientist in particular, who was not involved in the research, made wild-eyed claims – via press release, no less – that the findings meant that Brown was either not really cured or potentially had been re-infected.

The results of the study were published yesterday in the open access journal PLoS Pathogens, and the authors offer a sober discussion of their implications. [2]

In particular, they highlight the difficulty of formally proving a cure using current virologic assays that are operating at the limits of their sensitivity. Rather, they suggest, the waning of immune responses to HIV in Timothy Brown (both antibodies and T cells) may represent the clearest confirmation that he is indeed cured.

In the staid language of the methods section, the published paper also offers insight into the extent of Timothy Brown’s selfless commitment to contributing to HIV cure research: “The subject was enrolled in the UCSF-based SCOPE cohort and had multiple study visits over two years. Plasma, serum, and PBMC were obtained at each visit. The subject also consented to separate procedures at UCSF, including leukapheresis, lumbar puncture, and flexible sigmoidoscopy with rectal biopsies. He was also seen at the University of Minnesota, where he underwent a lymph node biopsy and a colonoscopy with ileal and rectal biopsies.”

Any one of these procedures might well prompt trepidation in most people even if they were medically indicated; to volunteer to undergo them for the purposes of research is extraordinarily laudable.