amfAR, The Foundation for AIDS Research

Making Sense of the Three Types of HIV Cure: The Berlin Patient, the Mississippi Child, and the VISCONTI Cohort

This March, news broke that a child from Mississippi, who tested HIV positive at birth, had been cured of HIV. Less than two weeks later, researchers reported that 14 individuals in France had been functionally cured of the virus. Five years ago, the first case of a cure occurred in an HIV-positive man with leukemia, known as the Berlin patient. “A decade ago, almost nobody spoke of curing HIV infection as a realistic goal, yet we find ourselves in early 2013 with not one, nor even two, but three different types of HIV cure,” said Rowena Johnston, Ph.D., amfAR vice president and director of research.

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Dr. Rowena Johnston (second from left) participated in a two-day pre-International AIDS Conference cure symposium in July 2012.

So what does this all mean? According to Johnston, “Much depends on how a cure is defined.” Experts currently define two categories of HIV cure. A sterilizing cure requires the complete eradication of all HIV from a person’s body. A functional cure requires only that even after patients stop antiretroviral therapy (ART), their HIV remains in remission and does not damage their immune system enough to cause any adverse health consequences.

So what does this all mean? According to Johnston, ‘Much depends on how a cure is defined.’

The French cases, known as the VISCONTI cohort, are viewed as functional cures. These patients began receiving ART within the first few weeks after they became infected, a time known as acute infection. Today they still have detectable HIV in their blood, but have been off ART for an average of seven years without any signs of disease progression. However, the researchers noted that only 10–15 percent of patients who are identified during acute infection and placed on immediate treatment can expect similarly controlled infections.

It remains less clear whether or not the Berlin patient and the Mississippi child experienced functional or sterilizing cures. Trace amounts of HIV have been sporadically detected in both patients since they went off treatment, but at such minimal levels that the tests could represent falsepositive results. In addition, research done to date has not identified virus in either patient that is capable of replicating, and therefore whatever is present does not appear to be causing harm to the patients.

"This case has galvanized discussion about the potential for immediate treatment of HIV-exposed infants to increase the chance of curing them in the future."

The Berlin patient was cured after he received a stem cell transplant from a donor with a very rare genetic resistance to HIV infection, a lifethreatening and costly process that cannot be recommended on a wide scale. The Mississippi child, on the other hand, was placed on ART at 31 hours after birth, before confirmation of HIV infection, an unusual approach that is not routinely practiced in the U.S. or in other countries. After 18 months of treatment, it was stopped and has not been restarted for over a year.

This was an unusual and unexpected outcome that further research will help to explain. Nevertheless, this case has galvanized discussion about the potential for immediate treatment of HIV-exposed infants to increase the chance of curing them in the future. “The case is a startling reminder that a cure for HIV could come in ways we never anticipated,” said amfAR CEO Kevin Robert Frost.