What researchers have learned about whether it can ‘cure’ HIV

It’s the news the HIV community has been waiting for four decades: the hint that maybe, just maybe, HIV can be cured.

Dr. Xu Yu, principal investigator at the Ragon Institute of Massachusetts General Hospital, MIT, and Harvard, as well as an associate professor of medicine at Harvard Medical School, had to check and double-check her results to be sure. sure. In one of her patients, trial after test to find evidence of HIV in the woman’s blood becomes empty. In addition to her lab results, “We’ve had additional tests in labs in Australia, DC and Argentina, where the patients are from, all trying to see if they can find any. any evidence of the virus being active or not, and absolutely nothing.” Yu.
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All told, the international team analyzed more than 1.5 billion cells from the patient, from Esperanza, Argentina, and no lab found intact traces of the entire HIV genome in the samples. hers. Woman tested positive for HIV after being infected from a sexual partner, but soon her body’s immune system was somehow able to control the virus and prevent it from spreading more copies of itself. her body and, more importantly, prevent it from forming latent reservoirs of the virus in places like the lymph nodes — all without the use of the potent anti-HIV drugs normally needed to prevent viruses. This is what sets the Esperanza patient apart. Unlike some other patients who were able to bring the virus under control, she showed no evidence of these reservoirs, while others did.

Yu, who reported the latest case in Annals of Internal Medicine. “The only thing we can say is that after analyzing a large number of cells from the patient, with the technology in our laboratory, we cannot disprove the hypothesis that the patient can achieve natural immunological cure for sterility.”

If that is the case, she would be only the second case of a patient to cure herself of HIV. Yu also describes the first patient, from San Francisco, in 2020, and the fact that she has now found a different method means that researchers can begin to study these patients to better understand about how these people were able to achieve such remarkable feats.

There have been previous reports of patients who stopped taking anti-HIV drugs and achieved undetectable virus level for many years: Timothy Ray Brown, also known as the “Berlin patient,” and most recently Adam Castillejo, “London patient. However, both have been diagnosed with cancer and benefit from a stem cell transplant for treatment, which will replace their immune cells with cells from donors. donation includes cells that can prevent HIV infection. And they likely continue to harbor latent reservoirs of HIV, which means they’re not completely cured, but what scientists call functionally curable.

That doesn’t seem to be the case with the Esperanza patient. Yu and her team have analyzed the woman’s 1.5 billion blood cells and tissues since 2017 and they did not find any evidence of intact viral genetic material indicating a virus. is likely to exist. However, they did find fragments of the viral gene, which suggests that the patient was indeed infected with HIV at one point. They found similar clues in the San Francisco patient.

Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a longtime HIV expert on the Esperanza patient, said: “This person’s body did this on its own. “It just happened. That means we have to try to measure every possible parameter and everything in that patient to see if we can find some hint that might be disseminated.” to the public or not.”

Patients continue to work with Yu’s team to provide blood samples for ongoing studies. She is currently pregnant with her second child, and Yu and the patient’s doctors are discussing whether her remarkable condition, the clear absence of the virus, means she will not need to be treated. medication or not. anti-HIV drugs before and during delivery, as current guidelines recommend for HIV-positive pregnant women. She took these drugs for six months during her first pregnancy to make sure any viruses she might have not passed on to her baby during delivery. Patient Esperanza is also planning to provide the team with samples of her breast milk after her baby is born so scientists can determine if it contains any viruses. .

While these two recent cases are encouraging, Yu cautions that the findings may not be generalizable to most. HIV patient. Both of her patients belong to the group of so-called elite controls, or those with very low levels of HIV suppression, often undetectable, with their immune systems without the help of anti-HIV drugs. The researchers don’t understand what it is about these people’s immune systems that allows them to control the virus so well, but they are studying these people in-depth, looking at everything from the antibodies they have. created to the highway that immune cells use, including white blood cells.

“I continue to be cautious,” Fauci said. “You can never really tell if the virus has completely left its hiding place in the body or just hasn’t emerged for any reason until the right circumstances, but evidence of this concept in my mind is much more relevant than in stem cell transplant cases. Because no one is manipulating this person. It just happened. For me, a) that’s rare. And b) I don’t know for sure if she really got rid of the virus, but even if she hasn’t, she is controlling it very strongly. If we can handle that, it will be very helpful to us in our quest to develop a cure for people affected by HIV. “

Similarly, Yu hopes that these patients and others like them, who may now continue, will help answer important questions such as whether regulating anti-HIV drug combinations can now help others reflect on the reactions her two patients experienced. For example, one thing she hopes to do is compare the immune responses between these two patients with the immune responses of people taking anti-HIV drugs. It is possible that the cocktail produced a weaker immune response than the one produced by these two patients, and scientists could find ways to boost that response. “We are actively studying the durability and strength of their responses and comparing them to those treated with combination therapy,” says Yu. “I hope that as more people become aware of these cases, they will approach us so we can better understand their immune systems.”


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