The Decibel - The first Canadian effectively cured of HIV

Episode Date: April 28, 2026

Only 10 HIV patients worldwide are known to have achieved the milestone of being in prolonged remission. Soon, a Toronto patient will be part of the historic achievement, becoming the 11th patient and first Canadian to be effectively cured of HIV. Doctors at the Canadian Conference on HIV/AIDS Research revealed that a patient underwent a stem cell transplant that is creating a natural immunity against the virus. Jennifer Yang, health science reporter for The Globe, delves into the complicated procedure and advancements in HIV treatments, speaks to the doctors leading the medical research and explains why there’s still a long road ahead for breakthroughs. Questions? Comments? Ideas? Email us at [e-mail] Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

There are just 10 people around the world who are considered to be cured of HIV. But this past weekend, doctors at an HIV research conference revealed that an 11th person will likely be added to that list. A Canadian man, known only as the Toronto patient. More than 40 million people are living with HIV around the world. And in Canada, it's over 65,000. Today, Jennifer Yang, the Globe's health science reporter, is here to talk about how this patient's HIV was treated and what a breakthrough like this means for the quest to find a wider cure for the disease.

I'm Cheryl Sutherland and this is the Decibel from the Globe and Mail. Hi, Jennifer, thanks so much for joining me today. Hey, thanks for having me. So Jennifer, the idea of this Canadian patient being possibly cured of HIV is going to sound really exciting to a lot of people. Can you help us understand how big of a deal is this? You know, it's both like a really big deal, but at the same time not going to significantly change anything anytime soon

for the world's HIV patients. So let me unpack that a little bit. I mean, obviously it's a big deal because this person is the first Canadian with HIV to ever be on track to be cured of his virus. There's just no way around that that is a milestone. But the way that they cured his HIV is not an accessible treatment that most people with HIV are going to be able to, you know, have access to. Okay. So it's not going to be accessible to everybody. But it is a very interesting and I think exciting time because it is a breakthrough, especially for Canada, because it's the first Canadian patient to be possibly cured of HIV.

Can you help me understand what does. does it mean to be cured of HIV? That's a really good question. So people with HIV are living longer than ever. In some cases, they have comparable life expectancies as people who don't have HIV. And that's all thanks to antiretroviral therapies. HIV patients on these drugs can control their viral loads to the point where it's completely undetectable in their blood. So you could say that, you know, people on these medications, you know, are living very normal lives. just managing a chronic illness. But the thing about this HIV virus, it's pretty sneaky. It can really hide inside cells inside the body where it kind of lays dormant for a while. And when people

go off their medications, the virus will just come roaring back within a matter of two weeks. Oh my goodness. So it's in the body to be really cured of HIV, that means you're getting rid of this viral reservoir where you can stop your medications and the virus won't come back. Okay, so someone that's on antiretroviral medications, they basically have to take this every day for the rest of their lives, basically. For life. Okay. And so this cure is something that you don't have to take the medication, right? Exactly.

You are cured of HIV. You no longer have to take medications. You don't have to really think about the virus anymore. You're HIV-free. Wow. Let's talk about the Toronto patient. What do we know about his case? We don't know a lot.

He's requested anonymity. So we don't know who he is or really much about his biography. But I've been able to speak to his doctor who's been treating him since 1999. And she's been able to share a little bit of information about his journey. So what we know about this fellow who's now 62 years old and living in Toronto is that he was first diagnosed with HIV in 1999. And actually, the reason he went to the hospital was not for his HIV. It was because he had developed cancer, a rare form of very great. aggressive cancer that is associated often with HIV. So when his doctors saw him showing up at the

hospital with this cancer, they suspected he might have HIV as an underlying cause. So he was also tested for that. And unfortunately, for him, it came back positive. So you can kind of imagine how devastating that moment would have been for him. He has been told he has cancer that he'll likely die from. And he's also been told that he is HIV, which will also likely kill him. And in fact, his doctors believed he probably wouldn't live for longer than six months. Oh my goodness. So this effectively felt like a death sentence at the time, but against all odds, he survived. He pulled through. He was treated aggressively for both his cancer and his HIV, and he lived. And his doctor, Sharon Wamsley, she refers to that moment as miracle number one for this patient. Okay. So can you help me understand

and how he went from possibly dying to being able to survive. It was miracle number one. How did he get there? Well, he was treated aggressively for his cancer and put on antiretroviral therapies, which had just come online at that time. You know, he was diagnosed at a really important moment in the arc of HIV history. But there was a downside to this cancer therapy that at the time saved his life. One of the known risks of the toxic cancer therapies he underwent at the time was that he could develop a syndrome down the road, which would predispose him to developing an aggressive form of leukemia.

And in fact, that's what did happen two decades later in 2020 when he found himself back in the hospital and now he's got a new cancer diagnosis. Oh, my goodness. Okay, so what happened next? So he was treated for that cancer. Dr. Wamsley said that she remembers reviewing his blood counts and they were off. And her heart kind of sank right away. She knew what this likely meant. She referred him for cancer treatments. And indeed, he did have the syndrome that progressed to aggressive leukemia. He was treated with chemotherapy and radiation. His cancer was sent into remission. But knowing what they knew, the cancer was very likely to come back probably in a matter of months. And so at that point, his doctors referred him for a stem cell transplant. Okay, so let's unpack what we're going to talk about now. And I think people have heard about stem cell transplants, but can you just explain what it is and how it's used as a cancer treatment? Yeah, I think maybe most people will know it by its other term, which is a bone marrow transplant.

So effectively, what it is is replacing your entire immune system. And in order to do that, a patient would have to first undergo chemotherapy and radiation to wipe out their own immune system, and then they replace it with stem cells from a donor with a healthy immune system. And so that is sort of a last resort treatment for blood cancers, like the one that this patient had. And so that was what he was agreeing to do in signing up for, and it's a very risky, complex, and resource-intensive treatment. Can you help me understand how the HIV treatment factors in here? Okay. So what happened next is kind of a stroke of kismet.

The person in charge of transplants at Princess Margaret Cancer Center, where this patient was referred is a doctor named Jonas Mattson. He's originally from Sweden, and he had worked at Oslo University Hospital, where his colleagues there had been treating an HIV positive patient who underwent a stem cell transplant that effectively cured that person's HIV. So this person's known as the Oslo patient. He's the world's 10th person to be cured of HIV. And in fact, nature microbiology, a very prestigious journal published about his case just the other week. So Dr. Mattson was well aware that stem cell transplant was a way that people with HIV could be cured of their virus. He had also heard about the first person to undergo this procedure and be cured of his HIV. So when he was recruited to Toronto to work for Princess Margaret, he had a goal of wanting to be positioned to do the same here.

He implemented a policy at the hospital where he asked all doctors referring cancer patients to his program for stem cell transplants to check a box indicating whether they were HIV positive or HIV negative. And that way they would know right away to look for a donor for their stem cell transplant that could potentially also pay for HIV-positive. the way to curing their HIV. Okay, help me understand how that's possible. Like, how is a stem cell transplant able to cure HIV at the same time? So what's so fascinating is that there are some people walking among us who are effectively resistant against HIV infection. They have this superpower, and it's because of a mutation they have on a gene called the

CCR5 gene. Huh. I didn't know that. Wow. Yes, and, you know, it's an estimated that something like 1% of people of European ancestry have this gene mutation. And how it works is the HIV virus needs to get into cells in order to infect them. And it does this through a receptor on the cell, a protein called the CCR5 receptor. And it acts like a little gateway into the cell.

And that's how the virus gets in to invade. people with this mutation, they don't have that little door on their cells so the virus just can never get in. So that makes them naturally resistant to HIV infection. That's incredible. Yes. So now imagine you're someone with HIV needing a stem cell transplant and your doctors are searching the global registry for potential donors. What you can potentially do is find an ideal donor that will provide the stem cells that are optimal for you. But you can also check if the donor might have this gene mutation, which would basically confer their resistance to you. So a person that's a stem cell donor might not even know that they're HIV resistant until the doctor's test for it.

That's true. And not every stem cell donor registry will have that information for their donors. I believe only in Germany, in the U.S., maybe one or two others. They provide what's known as whole genome sequencing of their donors where they can see whether or not the people actually have this mutation. Okay, so just so I'm understanding, so a stem cell transplant from someone who has this genetic mutation can basically replace the recipient cells with cells that block HIV. Yes. Wow. Incredible. Do we know why these HIV-resistant people are mostly of European ancestry? And does that mean that it's mostly, you know, white people who would be eligible for this kind of treatment? I don't know why it's mostly people of European ancestry.

but yes, there is an inherent inequity in the stem cell transplantation world. Well, to start with actually, you know, the HIV issue aside, the vast majority of stem cell donors are white. And patients who need a stem cell donor, their chances of finding a match are better if the donor has the same ethnicity. So that's one piece. And then if you are also trying to find a donor who carries this gene mutation, it's also chances are better that you'll find a match. If you yourself are a white person, which the Toronto patient is. We'll be right back. How was this treatment discovered?

So the first patient to be cured this way is someone who was initially known as the Berlin patient. We now know his name is Timothy Ray Brown. He's from Seattle originally, and he contracted HIV in the 90s in Berlin when he was a university student. And similar to our Toronto patient, he went on to develop cancer that required a stem cell transplant. His doctor at the time had the idea that they would look for a donor or selected donor who carried this gene mutation. So he tried this, and this patient actually also later got a second stem cell. cell transplant, but he was the first person to be cured of HIV. They were a little hesitant to say that initially, but they tracked him over the years, and he remained HIV free until his

eventual death from cancer and not from HIV. So he's known as the first to ever be cured of this virus, and when news of his case broke, it was very surprising to the HIV community. People were shocked, delighted, but also didn't know what to make of it, because it was clear that this was not a treatment that could be skilled up or would be accessible to all, and they didn't know if he would remain HIV-free for his entire life. But as time went on, it was clear that he was cured, and then more and more patients were able to also achieve cures through similar means. So you mentioned that patients are on antiretroviral medication to treat their HIV, but to be considered cured, you have to be off this medication and show no signs of HIV in your system.

How long does a patient have to be off their antiretroviral therapy to be considered cured? This is a bit of a live question because there are only 10 people worldwide who've been cured via stem cell transplant. But the current benchmark that they've set is 30 months. If you are able to stop your antiretroviral therapies and stay HIV-free for 30 months, then the physicians and researchers feel comfortable declaring that. person cured of HIV. And this Toronto patient is, I guess, considered in remission, but not yet at that point. Yeah, his doctors and the researchers who are studying his case are being very careful with the language. They're describing him as currently in prolonged remission. He's 10 months out from

stopping his medications. And so they'll be tracking him for another 20 months and seeing if his virus comes back or he shows any signs of active infection or any signs of having a viral reservoir. and when they hit that 30-month mark post-ceasing his medications, that's, I think, when they'll let out a big sigh of relief and feel comfortable declaring him cured. Let's talk about this Toronto patient a little bit more. He fit the mold of the type of patient who could receive the treatment that could cure both the blood cancer and HIV. How did the procedure go?

So the procedure itself went very smoothly. I think people will be surprised to know that a stem cell transplant is very quick. I think it happens in an hour or just over an hour and you're kind of in and out. But the lead up and the aftermath is extremely grueling and punishing. I mentioned before that to be conditioned for a stem cell transplant, you first have to wipe out your own immune system. So that's, I believe, five days of chemotherapy and radiation. And then when you have no immune system, you're obviously at risk of infection and getting well, so all kinds of complications can occur. And this patient had a series of complications post-transplantation that are quite common, but can be very serious, if not life-threatening. He developed multiple infections. He broke his hip, which I believe is kind of a result of the steroids that he had to be on that weakened his bones, and so he required a hip replacement. he also developed a rather common post-transplantation complication called graft versus host disease. And this is kind of where his new immune system is now attacking the remnants of his old immune system and his body.

And this also can be a life-threatening complication after stem cell transplantation. So this patient was kind of in and out of hospital for four years after his transplant, dealing with all kinds of complications. Yeah, so it's not straightforward. Like you mentioned, it's a very risky procedure and there could be many complications there. How is he doing now? I believe he's now doing great. By all accounts, he's doing very well. His cancer is also in remission and that's great. There's always been a fear that his cancer could also relapse after transplantation and that is a risk. But by all accounts, he's doing well. Having his HIV cured or at least we believe it's been cured, That doesn't really change his day to day. He was on antiretroviral therapies before, which kept his viral load at undetectable levels. So he, you know, he's kind of living in the same way as he was before he was cured and had this transplant. Only now he doesn't have to take that pill a day. But he's very, from what I'm told, he's very happy and excited that he was able to contribute to HIV research and add to our understanding of the virus and also how to potentially find a more widely. accessible cure.

Outside of this research, as we've talked about a little bit here, is antiretroviral drugs help people live long with HIV. So has that had an impact on looking for a cure? Like, has a cure become less of a necessity? I do think there's a feeling that maybe, because of the huge success of the anti-retroviral therapies, it's somewhat dampen the zeal that, you know, the research community has. for finding a cure. But people are very much still chasing a cure. There are so many reasons still to look for an HIV cure. I mean, so many patients around the world can't access antiretroviral

therapies easily or afford them. This is a continuing, if not growing, problem globally. And also, there's still a lot of stigma associated with being HIV positive that can have all kinds of detrimental effects on a person's life. And so there are still researchers, companies that are very much motivated to still find a cure that can be widely accessible to the globe's entire HIV positive population. And what is the state of HIV AIDS globally right now? You know, we're in a funny moment because the progress we've made in the fight against HIV is incredible. We have these antiretroviral therapies. We now have 11 people, we believe, who've been effectively cured through this extremely complex and resource-intensive stem cell transplantation process.

But at the same time, so many people are struggling to access therapies or the supports they need to live with this virus. And we've seen recently massive funding cuts across the globe that's most heavily impacted people in lower-income countries where the HIV burden is highest. people are least able to afford and access these drugs. So there are a lot of fears that we're in a really bad moment in the fight against HIV because people are losing access or having a harder time accessing the therapies they need. Okay, so Jennifer, this is, of course, a really exciting prospect to think about HIV being cured. But we're only talking about 10, potentially 11 people out of 40 million, right? That's a huge discrepancy there.

And as you've said, this is a very risky procedure. So can you explain how this helps us get closer to a cure for the wider population of people living with HIV? Yeah, that's a really good question. You know, as we've already discussed, stem cell transplants can't be done willy-nilly, and they will never be recommended to a patient just to cure their HIV. It's only a last resort treatment for an aggressive life-threatening cancer in a patient that happens to have HIV. But scientists studying these cases. cases are still really excited. It provides a lot of hope for the broader community that we can still

learn things and push the envelope on what's possible in HIV treatment and cures. But also these cases are revealing new insights into how the virus works, but also how a cure could work. It's showing the mechanism of a cure. And I think a lot of people are excited about taking these learnings and applying them to developing cures that would be more widely available, would be more accessible, and ideally a lot cheaper. So I think we're learning more about the virus and a potential cure every time another patient is able to achieve a cure this way. And we now have 11 patients a decade and a half ago, we only had one. So with every additional patient, we're getting more data. We're learning more and it's revealing potentially new insights.

To come back to the Toronto patient, his doctor has been working with him for more than 20 years. What did she have to say about this? She's so thrilled. I mean, she's such a long-time veteran of the HIV fight, like talking about people who've been on the front line since day one. She was just an intern in 1983 working her very first shift at Wellesley Hospital, not even around anymore, when, And she saw one of Toronto's very first recorded cases of AIDS. And that moment set her entire life on a new track where she devoted the rest of her career to treating patients with HIV and AIDS and studying this virus and looking for ways to treat it, to potentially cure it and to make lives better for people living with this awful virus. So she has just seen the full arc of this HIV story from a time when all she could do was sit on someone's bedside and hold their hand while they died and watch them dying to this moment where she is now the physician of the very first person in the country to be effectively cured of HIV.

So I think it's kind of mind-blowing for her to experience this and to witness this. She's very happy, but she's also very realistic and emphatic that there's still so much work left to be done. One of the first things she emphasized in our conversation was this is not a cure that will be accessible to the vast majority of HIV positive patients. So I think she's holding both of those emotions and both of those sides of the story at once. Jennifer, I think that's a wonderful place to end it on. Thank you so much for being on the show. Thanks for having me. That was Jennifer Yang, the Globe's health science reporter.

That's it for today. I'm Cheryl Sutherland. Our associate producer and intern is Emily Conahan. Our producers are Madeline White, Rachel Levy McLaughlin and Mikhail Stein. Our editor is David Crosby. Adrian Chung is our senior producer, and Angela Pichenza is our executive editor. Thanks so much for listening.