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Please explain. Cure or no?
Aug 31, 2013

So as we all now there is no cure to date. However we have these so called reports or studies of 14 functionally cured individuals. Alongside that...there have been those reports of the two men who have been cured via their transplants. Timothy Brown and I can't recall the other Lad. But they state that they have no virus at all. Making them the only cured whose virus has been completely eradicated...Is this correct? If this disease is so complex and no cure hasn't been made after 30+ years. How and why would those of us who are infected have hope or hold our breath? Not trying to a pessimist. But it just doesn't seem like it is going to happen. One of my friends happen to make an observation about Magic Johnson. He found out in 1991 that he was HIV positive. If he really was/is. Shouldn't he of passed away by now. Especially since the drugs then were so Harsh on the system. They even used to say that the drugs then were almost a catalyst to being closer to death instead of becoming healthy. With the coat of healthcare going up and this plateau of HIV med and lack of cure. How can one be but feel as defeated?

Response from Dr. Young

Hello and thanks for posting.

First, let's talk about Magic-- he does have HIV infection. He is not cured. Aside from being a talented athlete and wealthy, he's not medically special, he's just someone who accessed medical care and stays adherent to his medications. Just like many of my patients who have survived since the 1980's and 1990's, they are a bit lucky, but mostly the benefactors of incredible advances in HIV medicine.

Next, there have been several documented cases of "cure" of HIV- including Timothy Brown (the "Berlin patient"), the "Mississippi girl" (a case of cure in an infant, not involving transplant) and two more cases from Boston presented at this year's IAS2013 conference. Add to this, additional case reports from Europe (the "14 functional cures") of the effects of very early treatment, and in total, a very encouraging, if scientifically early, set of information that says that cure is possible.

No one is suggesting that bone marrow transplant is the path forward for curing the millions of people living with HIV, so this goal will require additional novel strategies. Indeed a recent publication looking at others who have had bone marrow transplant shows that HIV is still detectable in many. On the other hand, it's entirely possible that starting on treatment very early during infection (as was seen in the Mississippi case) might actually prevent the hundreds of thousands annual of pediatric HIV/AIDS cases.

I share with you my differing opinion about the plateau in HIV meds- we just saw the approval of the latest HIV medication, dolutegravir (Tivicay)- the result of a scientific program that saw for the first time in over a decade, results from two large clinical studies *superior* to our current care standards. This suggests that even today, very significant improvements in treatments are happening. Three years ago, "HIV cure" was just a research goal; today we have several documented cases of cure. The pendulum has swung.

So, just as having long-term survival of HIV/AIDS was difficult to envision in the 1980's, functional cure and complete cure of HIV/AIDS today might seem difficult to envision in the 2010's. But the past few years of information have been transformational in their glimmer of the possibilities. I don't think of myself as a blind optimist, but rather a believer that scientific efforts, if given time and adequate funding has, and will continue to find very significant advances to our knowledge and eventually treatments for HIV. It may take years, maybe decades, but I think that the current trend suggests that functional cure may indeed be achievable.


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