Berlin Patient

Cases

The first Berlin patient, who remains anonymous, was reported in 1998. After an experimental therapy, this individual has kept HIV levels low and has not taken antiretroviral drugs since. The second Berlin patient, Timothy Ray Brown, underwent a bone marrow transplant on February 7, 2007, to address both his leukemia and his HIV. Dr. Gero Hütter shared the outcome at the CROI 2008 Conference in Boston.

Brown received stem cells from a donor with natural HIV immunity and has been off antiretroviral therapy from the day of his transplant. Nathalia Holt's 2014 book 'Cured: The People who Defeated HIV' covered both stories. The Visconti Cohort, fourteen patients given early HIV treatment, were described in a 2013 paper as being in long-term virological remission, meaning the virus remains in their bodies but at low or undetectable levels without therapy.

Two Visconti members later resumed antiretroviral therapy—one due to rising viral load and falling CD4 counts, another because of a cancer diagnosis. A third member showed clear CD4 decline over time, as revealed in the final slides of a 2015 presentation by Asier Sáez-Cirión. Timothy Ray Brown is the only person considered to have a sterilizing cure, with strong evidence that no infectious HIV remains in his body.

Anonymous: the 1998 Berlin patient

The first Berlin patient was a German man in his mid-twenties treated by Dr. Heiko Jessen in Berlin. He was diagnosed with acute HIV infection in 1995 and given an unusual drug combination: didanosine, indinavir, and hydroxyurea. Hydroxyurea, a cancer drug not FDA-approved for HIV, was part of a small trial Jessen ran during acute infection.

After several treatment interruptions, the patient stopped all therapy, and his viral load became nearly undetectable. He has stayed off antiretroviral drugs ever since. A 2014 New England Journal of Medicine follow-up suggested his viral control likely stems from genetic factors, noting he carries the HLA-B*57 allele, which is linked to HIV control, and that many of his CD8 T cell responses targeting HIV are restricted by HLA-B*57.

Timothy Ray Brown: the 2008 cured Berlin patient

Timothy Ray Brown, originally from Seattle, Washington, was diagnosed with HIV in 1995 and began antiretroviral therapy. In 2006, he was diagnosed with acute myeloid leukemia. His physician, Dr. Gero Hütter at Charité Hospital in Berlin, arranged a hematopoietic stem cell transplant from a donor with the delta32 mutation in the CCR5 gene. This mutation, found in about 16% of Northern Europeans as heterozygotes and 1% as homozygotes, produces a nonfunctional CCR5 protein that most HIV cannot use to enter cells.

Brown received two transplants from the same homozygous donor, one in 2007 and another in 2008. He stopped his HIV medication on the day of the first transplant. Three months later, his HIV levels dropped to undetectable and his CD4 count rose. Tests on blood and tissue from HIV reservoir sites were published in the New England Journal of Medicine.

As of 2011, Brown remained off therapy and was considered cured, though debate continued over whether it was a sterilizing or functional cure. Brown died on September 30, 2020, after a five-month battle with leukemia.