Medical Examiner

What’s a Cure, Anyway?

The blockbuster news that a second HIV patient is in full remission shows us the limitations of our language.

HIV virions budding from a cultured human lymphocytes.
Numerous HIV virions (spherical in appearance) budding from a cultured human lymphocytes.
Courtesy C. Goldsmith, P. Feorino, E. L. Palmer, W. R. McManus/CDC/Handout via Reuters

An HIV cure “remains elusive.” Such is the modest opening of a splashy paper published yesterday in Nature. The scientists go on to describe a remarkable feat: A man with HIV has been in remission for a full year and a half, following a bone marrow transplant, during which he took none of the antiretroviral drugs that are typically needed to manage the infection. It is no doubt great news for this field of science, and for this one man. But, the authors write, “it is premature to conclude that this patient has been cured.”

Nevertheless, “HIV is Reported Cured In A Second Patient,” announced the New York Times in the headline of its story that broke the news ahead of the journal report. That headline let even President Trump’s tweet on the news, for once, seemed entirely measured: “Such great news for so many. Tremendous progress being made!”

The circumstances of this patient, and the other who received a bone marrow transplant in 2007 and has been in HIV remission since, are remarkably specific: They both received the transplants in order to treat cancer. And even of HIV patients that received similar transplants, they are the only two for whom it has so far worked to quell the infection; in other cases, the virus has come back. And of course, in the most recent case, it remains to be seen if the virus will remain in remission in the years to come.

The NYT article, written by Apoorva Mandavilli—along with her helpful and clear companion explainer on what all this actually means for people—reports all this nuance. The piece explains that, even if it works in the long term for these individuals, it isn’t practical for most patients anyway—it’s risky and comes with side effects, while drugs that effectively control infection already exist. It also explains why it’s throwing around the word “cure” at all—for one, the patient himself speaks of it as a cure: “I never thought that there would be a cure during my lifetime,” he wrote in an email to the paper. And as Mandavilli explains, “In interviews, most experts are calling it a cure, with the caveat that it is hard to know how to define the word when there are only two known instances.”

Far from an example of overzealous headlining, then, this HIV news makes a compelling case that we just plain need more words for our idea of “cure” in the first place. We need to be able to better express all the nuances between the two-off implementation of a risky tactic that can sometimes result in long-term remission, and the more colloquial understanding of a practical repeatable procedure that would be widely applicable. Indeed, health journalist Gary Schwitzer, founder of the (sadly no longer publishing) media watchdog site Health News Review, has suggested the word “cure” is so ineffective at accurately conveying meaning that it should be taken off the table in health journalism entirely. It’s “loaded and ill-defined,” he argues, placing it at the top of his list of “seven words you shouldn’t use in medical news.”

Journalists and organizations each grappled with how to use the word. Vox ran “cured” in the headline—in quotation marks. It’s an “apparent cure,” says the Los Angeles Times. A “functional cure,” notes a press release from UNAIDS. “An HIV cure may one day be possible” offers a New Scientist headline. NBC News went so far as to call the patient “confirmed to be cured,” but in the same breath cautioning, that it “does not mean a widely available cure is on the horizon anytime soon.”

What this “cure” does represent is a tantalizing line of scientific inquiry, perhaps good news for a few patients, and maybe far down the line, the basis for some new treatment options. In the meantime, the flurry around this news stands to dwarf more practically important matters in HIV treatment. As Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told NBC News, the “big breakthrough” is already here in “exquisitely effective drugs” that allow the majority of people who take them to lead regular lives. His focus is getting more people access to those.