Monday, November 14, 2005

Man "cured" of HIV?

I was browsing the medical blogosphere yesterday when I came across this story:
A hospital in London is to carry out tests on a British man reported to become the first person to be cured of HIV.

In August 2002, 25-year-old Andrew Stimpson was diagnosed as HIV positive.

However, 14 months later Mr Stimpson, who had not taken any medication for HIV, was found to be clear of the virus.

Mr Stimpson sought compensation for what he thought was an initial error but was told that there was no case to answer because there was no fault with the testing procedure.
Personally, I think they're getting a little carried away. Even if there was "no fault in the testing procedure," the most likely explanation is still that the first test was a false positive. No medical test, even perfectly carried out, is without false positives and false negatives. It is true that false positives are pretty rare with the combination of an initial ELISA for screening purposes followed by a Western blot or indirect immunofluorescence assay, but with millions being screened it is still inevitable that false positives will pop up now and then. Nonetheless, the man's original blood sample is still around, it should be retested.

Alternatively, possibly Mr. Stimpson is a carrier of the CCR5Δ32 mutation, which demolishes an HIV coreceptor on lymphoid cells and leading to a potent resistant to HIV infection in carriers (although it's unlikely that such a mutation would cause anti-HIV antibody to fall to undetectable levels so fast after being positive). It is also possible, albeit much less likely, that Mr. Stimpson's initial test was not a false positive and that he has some new form of resistance to HIV that can't be explained by the known mutation that confers HIV resistance (CCR5Δ32). In that case, he would definitely be worth studying.

Here's a prediction, though: Look for the HIV denialists to try to make some hay over this story if it gets out widely into the blogosphere. Just watch. Never mind that, even in the unlikely event that the first test was not a false positive and that Mr. Stimpson does indeed have some sort of previously undescribed resistance to HIV infection, it would not invalidate the data showing that HIV infection causes AIDS.

Consider my comments pre-emption.

(This is one prediction that will make me happy if I turn out to be wrong.)

(Via Kevin, MD and Medpundit)

ADDENDUM: Here's a more detailed account.

ADDENDUM #2: The whole story's starting to sound fishier and fishier. Mr. Stimpson is claiming he rid his body of HIV taking nothing more than vitamins and is now "declining" to undergo further testing, despite mounting pressure from the medical community and HIV advocates. Money quote:
Though Mr Stimpson insists he will "do anything I can", associates said yesterday that he had gone away to rest and escape the media spotlight.

Campaigners are annoyed that having not yet undergone the vital tests, Mr Stimpson nevertheless signed contracts with the News of The World and the Mail on Sunday, both of which published his claims yesterday.

They also sounded a note of caution, noting that disclosures in his case arose not from medical research or peer review but from legal correspondence relating to an action Mr Stimpson was pursuing against the health trust. He had feared the positive results might have been wrong and had sought compensation. The trust's contention that both sets of blood tests were accurate emerged as it tried to defend itself from litigation.

Mr Stimpson, who lives in London with his partner, who is HIV positive, said: "There are 34.9 million people with HIV globally and I am just one person who managed to control it, to survive from it and to get rid of it from my body. For me that is unbelievable - it is a miracle. I think I'm one of the luckiest people alive.

"I was just taking daily supplements to keep myself as healthy as possible so as not to get full-blown Aids."

But Annabel Kanabus, director of the Aids charity, Avert, said he must match words with deeds. "He must come forward. Organisations such as ours will be inundated this week. There is enough confusion surrounding the issue of HIV. We don't need any more."

She said the sequence of events is troubling. "He was told in October that he would not be paid by the trust so he goes to the newspapers. I think he should have gone straight to his doctors."
Sounds to me as though Mr. Stimpson may be looking to score some cash from this. Of course, his apparent greed doesn't rule out the possibility that his story is true and he did somehow "cure" himself with vitamins, but his behavior is making that explanation appear more and more dubious. There's only one way to find out. Here's hoping he permits the testing that needs to be done to sort out what happened.

(Hat tip to Kevin, M.D. again. And yet one more story here.)

ADDENDUM #3: It turns out that my initial prediction in the original post was correct. No big surprise there, as it was quite a safe bet. I would have been more surprised if I had been wrong.

12 example(s) of insolence returned:


At 11/14/2005 8:11 AM, Anonymous Anonymous said...

I had initially disregarded this story because I figured the first test was a false positive, but I didn't know about that mutation nor had I considered the denialist angle. Interesting stuff...

-Ali

 

At 11/14/2005 8:51 AM, Blogger The Probe said...

Assuming that the initial diagnostic test was a true positive, would the patient not have some form of antibodies now?

 

At 11/14/2005 10:01 AM, Anonymous Bruce McNeely said...

Consider these quotes from the article:

The trust said the tests were accurate but had been unable to confirm Scotsman Mr Stimpson's cure because he had declined to undergo further tests.

A statement from the trust said: "This is a rare and complex case. When we became aware of Mr Stimpson's HIV negative test results we offered him further tests to help us investigate and find an explanation for the different results.
"So far Mr Stimpson has declined this offer."

A trust spokeswoman added: "We urge him, for the sake of himself and the HIV community, to come in and get tested.

"If he doesn't feel that he can come to Chelsea and Westminster then he should please go to another HIV specialist."

and...

He has told the papers he would do anything he could to help find a cure.

I guess his definition of anything is different from mine.

 

At 11/14/2005 11:49 AM, Blogger Tara C. Smith said...

the probe said, "Assuming that the initial diagnostic test was a true positive, would the patient not have some form of antibodies now?"

Exactly. Assuming he actually *was* infected with HIV, the first test would measure antibodies. Even if he somehow cleared all the HIV from his body, he'd still test antibody-positive. Methinks this is a lot of noise over nothing.

 

At 11/14/2005 12:21 PM, Anonymous insider said...

Talk about exploiting the following:

1. People's desire for hope in the battle for aids.
2. Headline hungry media.
3. Bad math.
4. A young man's desire to capitalize on all of this somehow.

Makes me ill.

http://independentsources.com/2005/11/14/man-cures-himself-of-aids-not-likely/

 

At 11/14/2005 1:06 PM, Blogger Bill Hooker said...

Even if he somehow cleared all the HIV from his body, he'd still test antibody-positive.

It's plausible, though it would be astonishing, that his titre could have dropped that fast. Also, it's not clear from those stories whether he was tested for antibody or virus (PCR for vDNA or vRNA), especially on the followup test.

Also, in order to establish a detectable viremia (or, even more so, Ab response), the infecting dose must presumably have consisted of virus able to use an alternative pathway (eg CXCR4).

I sure hope he changes his mind about re-testing, and someone goes back over that original sample. It's probably an artefact of testing, but it should be followed up.

 

At 11/14/2005 4:58 PM, Anonymous Julia said...

It also sounds like confusion between antibody testing and viral load testing. His viral load at this point could be virtually undetectable at this point, but that would just mean that at the moment, the virus was dormant. His antibodies, of course, would still be positive.

 

At 11/15/2005 3:29 AM, Blogger JM O'Donnell said...

The whole thing could have been as simple as loading the wrong samples into the wells of the ELIZA. Although doubtful (antibodies are hard to fool) that the initial test was false it can happen. I am not sure what is going on however and would vastly prefer to see better details.

I'm still rather bemused by Dean Esmay and crew though. Some of the distortions on that one post alone...

 

At 11/15/2005 7:28 AM, Blogger Orac said...

Indeed. He's getting wingnuttier and wingnuttier about AIDS as time goes on.

 

At 11/15/2005 8:03 AM, Anonymous Chris said...

the hospital is insisting that both tests were accurate in order to avoid paying compensation, this must call into question their credibility?

 

At 11/16/2005 8:23 PM, Blogger HIV+DaveyBoy said...

If his body cured itself of HIV, I hope doctors can figure out how it was done as he has no idea. I am wondering if maybe his HIV testing results simply got mixed up at the lab? It's happened before...

I hope he will agree to further tests to figure out how this happened, my son's future (and millions of others, possibly a billion over the next 100 years) may just depend on a cure for HIV/AIDS as his mother and I have AIDS :(

This could also be a hoax to somehow disprove that HIV/AIDS exists or is a health threat (there are many AIDS dissidents out there).

 

At 11/25/2005 1:48 PM, Anonymous Anonymous said...

At the 11th European Conference on AIDS last week in Dublin, clinicians from the Chelsea and Westminster hospital verified more or less all that has been said above about this case.

They initially suspected the patient may have been seroconverting, because the first ELISA result was indeterminate, then positive. He was subsequently negative, and was negative by HIV-RNA PCR on more than one ocassion, although one PCR was minimally positive but at a level attributable to "background noise". Any genuine case of seroconversion would be associated with high levels of viraemia.

The patient has not returned for further tests, specifically ones to explore his T-cell responses to HIV antigens (and determine whether he was exposed, but somehow cleared infection, or whether the initial tests were what is thought to be highly likely - a false positive.

 

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