This, by no means, is a defeat.  HIV is a far cry of what it was 30, or 20, or even 10 years ago.  We are able to completely control the progression of the infection, relatively easily, with very tolerable medications. For instance, we currently have one called Atripla, which consists of three medications formulated into one single tablet, so the infected person takes only one pill a day, and that’s it.  In the next two years, we expect at least two other “single pills agents” to be released in the market.  So, for those with newly diagnosed infection, HIV treatment is about to get even simpler.  On the contrary, however, these simple regimens may not work for people who have taken HIV medication(s) in the past and have not responded well to the treatment. For people who fall into this category, they will still be able to benefit from the many significant advances in treatment which have recently been developed, but they will have to continue to take a greater number of pills per day.

Can a person infected with HIV run out of treatment options? Yes.  HIV medication inappropriately taken can cause the HIV to develop resistance, meaning the medications will no longer work as they should. We are starting to see a few people now in this difficult situation.  The lesson learned here, for both patients and HIV providers, is that we have to use wisely the armamentarium of HIV medications that are available today (and follow the recommended dosage with strict adherence) to avoid problems like this in the future. But for the most part, for people taking HIV medications, regardless if they are taking one, two, three, or more pills a day, if they are responding to therapy (meaning that their HIV cannot be counted in a routine blood test, better known as exhibiting an “undetectable viral load”), then those medications should work continuously as long as the individual takes them consistently (and/or in a less common scenario, the person does not get re-infected with another HIV virus strain).

Is anyone immune to HIV infection?  In an incredibly small percentage of people, a particular genetic mutation is present that makes them almost invulnerable to acquire HIV infection. We call those people “delta 32”.

Should I get tested? Yes! Studies have shown that a person who gets tested and receives a negative HIV test result is more likely to want to insure his/her HIV-negative status by incorporating the use of safer sexual practices.  For those who receive a positive HIV test result, it is much better for them to know their HIV status earlier than to wait for things in the body to start going wrong.  It is significantly easier to  maintain good health (through the use of medication) in an HIV positive person than to try to restore health to someone with HIV, whose immune system has been significantly weakened by the virus because he/she waited too long to begin treatment.

One of the most compelling reasons to start HIV medications is that it can reduce HIV transmission to other uninfected persons!  All the studies looking at this have reached the same conclusion: the lower the amount of HIV in someone’s body, the less likely that person is to transmit the infection to his/her sexual partner.    Having an undetectable HIV viral load is very important.  For example, studies in monogamous, heterosexual discordant couples (in which one partner is positive and the other one is negative) having vaginal intercourse only, as long as the positive partner was taking the medications and had an undetectable viral load, HIV transmission (even in the absence of condoms) occurred rarely in comparison to couples in which the positive partner was not on treatment.  In the case of anal intercourse, the chances of transmission by someone undetectable are higher than vaginal intercourse, but still very low.  The point is; becoming undetectable and staying that way is the ultimate goal!.  Regardless, condoms are recommended for protection against all sexually transmitted diseases.

So what about our lucky fellow whose HIV infection was cured?  His name is Timothy Ray Brown, but he is better known as “The Berlin patient”.  He had HIV infection and in an unfortunate turn of events he was also diagnosed with a form of leukemia (white blood cell cancer). The treatment that Mr. Brown underwent was very aggressive: chemotherapy that destroyed the majority of his immune cells and total body irradiation.  Mr. Brown then needed a very risky stem-cell transplant that nearly a third of patients don't survive.  Doctors in Berlin were very savvy to have found and chosen a “delta 32” donor (as mentioned earlier) for that transplant, and… “TA-DA”, not only was Mr. Brown’s leukemia cured, but that aggressive intervention, which nearly killed him, also got rid of the HIV as well.  In December of last year, after 3 years follow up, without taking HIV medications Mr. Brown was officially declared the first person to be cured of HIV infection.

Let’s make something clear: even if a simpler and safer procedure that would achieve similar results is discovered, it is not realistic to think that the procedure will be the cure for the 33 million people currently infected with HIV worldwide (because it will still likely be very complicated and expensive). Nevertheless The Berlin patient case was yet another step in the right direction, and we do need to celebrate all these steps.