Reports that a UK man has "cured" himself of HIV appear to be premature. Andrew Stimpson, 25, gave interviews to two UK Sunday newspapers, both of which included excerpts of a letter from the NHS Litigation Authority that claim Mr Stimpson had both an undetectable viral load and tested negative for HIV antibodies in 2003 and 2004. However, in 2002, the reports say, he had tested HIV antibody positive and had very low levels of detectable HIV. Although the NHS Litigation Authority letter says that all tests were definitely on Mr Stimpson's blood, and that the results were "exceptional and medically remarkable", they also requested Mr Stimpson to undertake further testing. However, the Chelsea and Westminster health trust told several newspapers yesterday that so far Mr Stimpson had "declined" the request.
Two versions of Mr Stimpson's story appeared on Sunday in the two best-selling UK newspapers, the News of the World, and the Mail on Sunday. It appears he had signed contracts with both.
Mr Stimpson, from Scotland, who lives in London with his HIV-positive boyfriend, told the News of the World in a story headlined I'm the first in the world to be cured of HIV that he believes he may have cured himself by taking vitamin supplements. He also says that once he had been told that he was HIV-positive he became depressed and gave up practising protected intercourse with his partner. Once he was told that he was no longer HIV-positive, he began litigation against the Chelsea and Westminster NHS Trust believing they had got his blood mixed-up. However, a letter confirming this was definitely not the case was reportedly received by Mr Stimpson last month.
Mr Stimpson says that he had initially sought an HIV antibody test at the Victoria Clinic for Sexual Health in west London in May 2002 after feeling tired, weak and feverish: symptoms that could suggest HIV seroconversion illness. Initial antibody tests were negative, which may have reflected a very recent infection before his body could begin to produce HIV antibodies. The amount of time between getting HIV infection and developing antibodies varies very widely. The vast majority of people with HIV will produce antibodies by around 45 days after infection. However, in a small proportion it may take up to six months for antibodies to develop, and in a very few people with HIV infection it may take even longer.
Three months later, in August 2002, the Mail on Sunday reported that Mr Stimpson had three further HIV antibody tests. The first, on August 15th was inconclusive. Two further antibody tests, on August 20th and 23rd were positive. Neither newspaper reports include details of the type of HIV antibody test done, nor whether these were confirmed by viral load or other more detailed testing, which would have measured levels of HIV in his body. However, a letter from the NHS Litigation Authority, parts of which were quoted in the Mail on Sunday, suggests that viral load testing done at the time found that Mr Stimpson had "exceptionally low" levels of HIV.
In October 2003, during a routine check-up, the Mail on Sunday report suggests that he had three confirmed undetectable viral load tests. The term 'undetectable' means that there is limit below which it is not possible to measure the amount of HIV present, usually 50 copies/ml, and indicates that a specific viral load test cannot find any HIV in a given blood sample. An undetectable result does not usually mean that the blood is free of HIV. In fact, most people with 'undetectable' viral load have HIV in their blood, as well as in blood cells, tissue and bodily fluids.
However, what is unusual is that Mr Stimpson appears to also have seroreverted from HIV-positive to HIV-negative. Another part of the letter from the NHS Litigation Authority says that in March 2004, he was "still HIV-antibody negative."
Earlier this year, aidsmap reported that seroreversion is possible, but rare, after early treatment of acute HIV infection, and there have also been previous anecdotal reports, none of which have stood up to further scrutiny, of this happening in untreated individuals.
Comment
It is too early to speculate whether Mr Stimpson's case is indicative of a 'cure', spontaneous, or otherwise.
Mr Stimpson and his stored blood samples need to undergo further rigorous testing to determine whether his initial or subsequent diagnoses were, indeed, correct.
Although the NHS Litigation Authority appears to have confirmed that DNA testing had determined his blood samples were not mixed-up with anyone else's, this does not confirm there were no lab or other errors with the HIV antibody or viral load tests.
Even if these tests, and further testing of Mr Stimpson, do suggest that he no longer has HIV, this could be due to various factors, including the strain of the virus itself or Mr Stimpson's genes.
Interestingly, Mr Stimpson claims to have had unprotected sex with his HIV-positive partner after August 2002, and that he was HIV antibody negative in March 2004. Research from a group of much studied Nairobi sex workers, who had remained HIV-negative despite frequent exposure to HIV, suggests that so-called 'immunity' from HIV infection may be a consequence of a steady level of exposure to HIV.
Of particular concern is the widespread media misreporting of the details of the case. Although many of the reports treat Mr Stimpson's claims with caution, others have taken them at face value, including the Australian Daily Telegraph and the Bangalore Deccan Herald. This may lead to a belief that HIV can be 'cured' spontaneously, or with vitamins, or that miracles can happen.
At the moment, until further scientific details can be reported, this anecdotal report is fascinating but unsubstantiated.