More than 15 years without HIV and without drugs: a functional cure for AIDS may be in sight

The human immunodeficiency virus (HIV) afflicts many lives, and once it arrives, it leaves the immune system no respite. Although this is the norm, in Barcelona a patient surprises researchers, virus-free for more than 15 years, without the use of any medication.

Is this a new path to a potential cure?

It is not a new virus and it caused a wave of prejudice and discrimination that haunted the 1980s. Although HIV infection is not linearly associated with the development of AIDSthe madness of the time motivated much misinformation regarding the disease.

If at the time it was strongly associated with certain lifestyles and sexual orientations, it now infects nearly 38 million people, the story is significantly different - although much remains to be clarified.

The search for a cure that frees infected people from this virus that attacks and destroys the defense mechanisms that protect human beings against disease has been relentless. However, although there are surprising advances and news that renew hopethe truth is that there is still no cure, there is only one way to suppress the virus and delay the progression of the disease.

O The country states that four decades of scientific advances have saved millions of infected people, thanks to antiretroviral therapy (ARVs) - a series of drugs that prevent the virus from reproducing to the point of making the viral load undetectable and, therefore, to make it non-transferable - which enables a normal, quality life for more than 28 million people.

While the current solution isn't ideal, it's cases like the Barcelona patient that intrigue researchers and motivate them to figure out how to permanently reverse HIV. The study was carried out by a team led by physicians from Clinical Hospital Barcelona and the results will be presented in the 24th International AIDS Conferencein Montreal, Canada, this week.

Over 15 years HIV-free without drug use

A Spanish woman, whose personal details were withheld to ensure anonymity, has had an undetectable viral load for more than 15 years, without taking medication. In a case where the researchers describe as "unique" and "exceptional", according to El País, the patient may represent the beginning of the discovery of a working cure for the disease.

This woman has been off medication for over 15 years. After a short period of time, she totally controlled the AIDS virus and this has a very important aspect: we managed to find out what is the possible mechanism that allows it.

revealed Josep Mallolashead of the HIV-AIDS unit at Hospital Clínic Barcelona, ​​during a press conference.

Josep Mallolas, head of the HIV-AIDS unit at Hospital Clínic Barcelona

Josep Mallolas, head of the HIV-AIDS unit at Hospital Clínic Barcelona

A patient from Barcelona was diagnosed in 2006 with an acute infection that is not typical in either of the two groups of rare exceptions when it comes to HIV: some people are called "post-treatment monitors" because they keep the spread of treatment by the virus. after stopping the drug; and others are “elite controllers” who achieve the same result without initiating antiretroviral therapy.

As revealed by El País, the patient was included in a trial led by José M. Miró, to see if the immune system could be stimulated to control the reproduction of the virus. In a sample of patients, one part received only antiretrovirals and the other received a set of additional immunomodulatory treatments.

Nine months after stopping treatment, this patient no longer had a detectable HIV viral load in her plasma.

The virus has not recovered, and has not recovered for 15 years and more than 50 viral load tests; it's not that sometimes I can't have a bit of low level presence. He has always been undetectable.

Clarified Núria Climent, researcher at the AIDS and HIV Infection Research Group at the Pi i Sunyer Biomedical Research Institute (IDIBAPS), during an interview granted by the medical team in El País.

The Barcelona patient was the only one of 20 individuals to react in the way the doctors described.

Patient response opens new doors to curing HIV

After discovering the patient's immune response, doctors infected HIV's main target, CD4+ T cells. With this, they verified that they were able to replicate the virus, so the problem was not in the entry of the virus into the cells.

However, when they cultured subpopulations of blood cells, they found that there was a very strong control of virus replication.

This suggested that these other subpopulations were involved. With in vitro tests, we have shown that these are so-called Natural Killer cells [NK] as well as CD8+ T cells.

One of the team's doctors, Sonsoles Sánchez-Palomino, explained to El País.

Our body uses NK cells to trigger an immune response when it comes in contact with the AIDS virus, and if they are strong, they can control it.

It is as if we are witnessing for the first time the undisputed victory of the immune system over the virus.

Famous Doctor Josep Mallolas.

Viruses can have their years numbered

According to El País, this investigation is important because it characterizes NK cell subpopulations and which subpopulations of CD8+ T cells could be involved: NK cells, which have memory, and Gamma-Delta T cells, which provide natural immunity. As Climent describes, "the patient has very high levels of both, and they can block or destroy those who are infected."

If we could, through treatment, replicate or replicate this woman's natural immune capacity, the benefits would be enormous.

Said Josep Mallolas.

From left to right: Josep M. Miró, Juan Ambrosioni, Sonsoles Sánchez-Palomino, Núria Climent, Josep Mallolas and José Alcamí

Although impressive, the researchers point out that the Barcelona patient differs from the London and Berlin patients, since in her case, despite a functional cure - controlling HIV replication without treatment - the cells possess a viable virus to cause. new infections. The other two, in turn, were able to purify their bodies through a bone marrow transplant.

You can't use it for the nearly 40 million people living with HIV. On the other hand, if you manage to detect a group with certain genetic material that, through certain interventions, can spontaneously control the virus, you will be doing something potentially much easier to develop.

The team is already planning the next steps. In the voice of Mallolas:

What is very important is to study this woman in depth, and once we know her cells and her 100% immunity, we can design research projects for other people, so that even if we cannot cure them, we can ensure that they can remain untreated, with an undetectable viral load and without the possibility of infection for many years. This opens up a fascinating array of research possibilities.

According to the researchers, at best the team will be able to find a definitive cure. On the other hand, in the worst case, the patient who has been a “super collaborator” and who has “given everything for science” could need to resume antiretroviral treatment.

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