AIDS, the Esperanza case: the patient no longer in treatment who has “eliminated” the virus. Second case detected in the world

“A sterilizing cure for HIV cannot be empirically proven” but that it can happen even if it is rarely possible. They are the authors of a published study Annals of Internal Medicine describing a second case of an HIV-positive person who no longer has traces of the virus that triggers AIDS. The premise is that instead the two cases recorded so far of “sterilizing treatment” had been detected in two people undergoing a particular type of transplant. The research, which could open up new research perspectives on the mechanisms of action of HIV and our immune system, was funded by the National Institutes of Health e Bill & Melinda Gates Foundation.

To understand the importance of this discovery we must remember that the HIV virus “inserts” copies of its genome into the DNA of the cells, creating what is called the viral reservoir. Thus the virus escapes the attack of antivirals and the body’s immune response. New viral particles are continuously produced from this reservoir. Antiretroviral therapy cannot clear the reservoir, requiring daily treatment to suppress the virus. Some people, known as elite controllers, they have an immune system capable of suppressing HIV. Although they still have viral reservoirs capable of producing more HIV, a type of immune cell called a killer T cell keeps the virus suppressed without the need for medication.

The research team from Massachusetts General Hospital, MIT and Harvard Medical School a year ago described above Nature the case of the “San Francisco patient” and has now found another “Esperanza” patient with an immune system capable of autonomously eliminating the viral reservoir. The woman found out she was HIV positive in March 2013. But she did not start any antiretroviral treatment until 2019, when she became pregnant and began taking the drugs tenofovir, emtricitabine and raltegravir for six months during the second and third trimesters of her pregnancy. . After giving birth to a healthy, HIV-negative baby, she stopped therapy.

Like the San Francisco patient, the patient Esperanza no longer has a trace of the virus despite the researchers having analyzed 1.19 billion blood cells and half a million cells taken from the tissues. “These results, particularly with the identification of a second case, indicate that there may be a viable path to a sterilizing cure for people who can’t do it on their own, ”says scientist Yu Xu. Understanding the immune mechanism underlying this ability could pave the way for the development of treatments that teach the immune systems of others to mimic these responses in cases of HIV infection.

Lo studio Annals of Internal Medicine

The study in Nature