By Kate Kelland
LONDON, June 1 (Reuters) - For his doctors, Timothy Ray
Brown was a shot in the dark. An HIV-positive American who was
cured by a unique type of bone marrow transplant, the man known
as "the Berlin patient" has become an icon of what scientists
hope could be the next phase of the AIDS pandemic: its end.
Dramatic scientific advances since HIV was first discovered
30 years ago this week mean the virus is no longer a death
sentence. Thanks to tests that detect HIV early, new
antiretroviral AIDS drugs that can control the virus for
decades, and a range of ways to stop it being spread, 33.3
million people around the world are learning to live with HIV.
People like Vuyiseka Dubula, an HIV-positive AIDS activist
and mother in Cape Town, South Africa, can expect relatively
normal, full lives. "I'm not thinking about death at all," she
says. "I'm taking my treatment and I'm living my life."
Nonetheless, on the 30th birthday of HIV, the global
scientific community is setting out with renewed vigour to try
to kill it. The drive is partly about science, and partly about
money. Treating HIV patients with lifelong courses of
sophisticated drugs is becoming unaffordable.
Caring for HIV patients in developing countries alone
already costs around $13 billion a year and that could treble
over the next 20 years.
In tough economic times, the need to find a cure has become
even more urgent, says Francoise Barre Sinoussi, who won a Nobel
prize for her work in identifying Human Immunodeficiency Virus
(HIV). "We have to think about the long term, including a
strategy to find a cure," she says. "We have to keep on
searching until we find one."
The Berlin patient is proof they could. His case has
injected new energy into a field where people for years believed
talk of a cure was irresponsible.
THE CURE THAT WORKED
Timothy Ray Brown was living in Berlin when besides being
HIV-positive, he had a relapse of leukaemia. He was dying. In
2007, his doctor, Gero Huetter, made a radical suggestion: a
bone marrow transplant using cells from a donor with a rare
genetic mutation, known as CCR5 delta 32. Scientists had known
for a few years that people with this gene mutation had proved
resistant to HIV.
"We really didn't know when we started this project what
would happen," Huetter, an oncologist and haematologist who now
works at the University of Heidelberg in southern Germany, told
Reuters. The treatment could well have finished Brown off.
Instead he remains the only human ever to be cured of AIDS. "He
has no replicating virus and he isn't taking any medication. And
he will now probably never have any problems with HIV," says
Huetter. Brown has since moved to San Francisco.
Most experts say it is inconceivable Brown's treatment could
be a way of curing all patients. The procedure was expensive,
complex and risky. To do this in others, exact match donors
would have to be found in the tiny proportion of people -- most
of them of northern European descent -- who have the mutation
that makes them resistant to the virus.
Dr Robert Gallo, of the Institute of Virology at the
University of Maryland, puts it bluntly. "It's not practical and
it can kill people," he said last year.
Sinoussi is more expansive. "It's clearly unrealistic to
think that this medically heavy, extremely costly, barely
reproducible approach could be replicated and scaled-up ... but
from a scientist's point of view, it has shown at least that a
cure is possible," she says.
The International AIDS Society will this month formally add
the aim of finding a cure to its HIV strategy of prevention,
treatment and care.
A group of scientist-activists is also launching a global
working group to draw up a scientific plan of attack and
persuade governments and research institutions to commit more
funds. Money is starting to flow. The U.S. National Institutes
of Health is asking for proposals for an $8.5 million
collaborative research grant to search for a cure, and the
Foundation for AIDS Research, or amfAR, has just announced its
first round of four grants to research groups "to develop
strategies for eradicating HIV infection."
THE COST OF TREATMENT
Until recently, people in HIV and AIDS circles feared that
to direct funds towards the search for a cure risked detracting
from the fight to get HIV-positive people treated. Even today,
only just over five million of the 12 million or so people who
need the drugs actually get them.
HIV first surfaced in 1981, when scientists at the U.S.
Centers for Disease Control and Prevention discovered it was the
cause of acquired immunodeficiency syndrome (AIDS). An article
in the CDC's Morbidity and Mortality Weekly Report of that June
referred to "five young men, all active homosexuals" from Los
Angeles as the first documented cases. "That was the summer of
'81. For the world it was the beginning of the era of HIV/AIDS,
even though we didn't know it was HIV then," says Anthony Fauci,
director of the U.S. National Institute of Allergy and
Infectious Diseases, who has made AIDS research his life's work.
In the subsequent three decades, the disease ignorantly
branded "the gay plague" has become one of the most vicious
pandemics in human history. Transmitted in semen, blood and
breast milk, HIV has devastated poorer regions, particularly
sub-Saharan Africa, where the vast majority of HIV-positive
people live. As more tests and treatment have become available,
the number of new infections has been falling. But for every two
with HIV who get a chance to start on AIDS drugs, five more join
the "newly infected" list. United Nations data show that despite
an array of potential prevention measures -- from male
circumcision to sophisticated vaginal or anal microbicide gels
-- more than 7,100 new people catch the virus every day.
Treatment costs per patient can range from around $150 a
year in poor countries, where drugs are available as cheap
generics, to more than $20,000 a year in the United States.
The overall sums are huge. A recent study as part of a
non-governmental campaign called AIDS2031 suggests that low and
middle-income countries will need $35 billion a year to properly
address the pandemic by 2031. That's almost three times the
current level of around $13 billion a year. Add in the costs of
treatment in rich countries and experts estimate the costs of
HIV 20 years from now will reach $50 to $60 billion a year.
"It's clear that we have to look at another possible way of
managing of the epidemic beyond just treating everyone forever,"
says Sharon Lewin, a leading HIV doctor and researcher from
Monash University in Melbourne, Australia.
In some ways, we have been here before. Early AIDS drugs
such as AZT came to market in the late 1980s, but within a
decade they were overtaken by powerful cocktail treatments known
as HAART, or highly active antiretroviral treatment. HAART had a
dramatic effect -- rapidly driving the virus out of patients'
blood and prompting some to say a cure was just around the
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