AIDS is a disease of staggering numbers, of tragically recursive devastation. Since the first diagnosis, 30 years ago this June 5, HIV has infected more than 60 million people, around 30 million of whom have died. For another 5 million, anti-retroviral therapy has made their infection a manageable though still chronic condition. Until four years ago, Timothy Brown was one of those people.
Brown is a 45-year-old translator of German who lives in San Francisco. He is of medium height and very skinny, with thinning brown hair. He found out he had HIV in 1995. He had not been tested for the virus in half a decade, but that year a former partner turned up positive. “You’ve probably got only two years to live,” the former partner told him when Brown got his results.
His partner was wrong—lifesaving anti-retrovirals were about to arrive—and Brown spent the next ten years living in Berlin, pursuing his career and enjoying the city by night. He was gregarious, a fast talker; when he went out, he’d always wind up the center of a group. “I used to be quite a flirt,” he tells me. “I would see someone in a café, bar, or disco and knew how to get what I wanted.” In 2006, Brown was living in Berlin with his boyfriend, a man named Michael from the former East Germany. That year, on a trip to New York for a wedding, he began to feel miserable. He chalked it up to jet lag, but it didn’t go away. Back in Berlin, his bike ride to work took so long that he got chewed out by his boss for lateness. Michael called his doctor, who saw Brown the next day.
The results came back: leukemia. A new, unrelated disease was now threatening his life. Michael cried. Brown was referred to Charité Medical University, where he was treated by Gero Hütter, a 37-year-old specialist in blood cancers.
After chemo, the leukemia came back. Brown’s last chance was a stem-cell transplant from a bone-marrow donor. Hütter had an idea. He knew little about HIV, but he remembered that people with a certain natural genetic mutation are very resistant to the virus. The mutation, called delta 32, disables CCR5, a receptor on the surface of immune-system cells that, in the vast majority of cases, is HIV’s path inside. People with copies from both parents are almost completely protected from getting HIV, and they are relatively common in northern Europe—among Germans, the rate is about one in a hundred. Hütter resolved to see if he could use a stem-cell donor with the delta-32 mutation to cure not just Brown’s leukemia but also his HIV.
Hütter found 232 donors worldwide who were matches for Brown. If probabilities held, two would have double delta 32. Hütter persuaded the people at the registry to test the donors for the mutation; his laboratory paid, at a cost of about $40 per sample. They worked through the list. Donor 61 was a hit.
His colleagues and the chief of his unit were dubious. “The main problem was that I was just a normal physician—I had no leading position. It was not always easy to get what we needed,” Hütter recalls. Brown himself was not pushing the idea. “At that point, I wasn’t that concerned about HIV, because I could keep taking medication,” he says.
Before Hütter asked the donor registry to begin testing, he’d searched the literature and contacted AIDS experts. It dawned on him that no one had ever done this before. “My first thought was, I’m wrong. There must be something I was missing.” In a sense, that was true. Gero Hütter did not know what most AIDS researchers and clinicians had taken as accepted wisdom: A cure was impossible.
The 1996 International Conference on AIDS in Vancouver brought the stunning announcement that a combination of three anti-retroviral drugs could keep HIV in check. David Ho, director of New York’s Aaron Diamond AIDS Research Center, went further. In the closing session, Ho said that it might be possible to eradicate the disease from the body with 18 to 36 months of therapy. Time magazine named Ho “Man of the Year.”
But Ho was too optimistic. Treatment with the drugs, no matter how early it’s begun, cannot eradicate HIV, because the virus hides, lurking in the brain or liver or gut without replicating, invisible to the immune system. It is waiting to come roaring back if therapy is stopped. Disillusioned, some cure researchers transferred their finite resources and energy to improving AIDS treatment or working on a vaccine. Money for cure research dried up. Some scientists took to calling it “the C-word” or “cure” with air quotes.