Hiv, is it possible to suspend therapy when the virus is unable to replicate? – breaking latest news

To date there is no cure capable of permanently eliminating the HIV virus from the body. People living with this infection need to take an antiretroviral therapy for life to keep the virus under control by preventing it from replicating in the blood. “One of the challenges of the scientific community in the fight against HIV is to allow people with a virus that does not replicate itself to withdraw from therapy,” he says. Claudio Mastroianni, professor of infectious diseases at the Sapienza University of Rome and president of the Italian Society of Infectious and Tropical Diseases. A goal he’s working towards the Bambino Gesù hospital in Rome together with the Massachusetts Institute of Technology (in Boston). The team of researchers, coordinated by Paolo Palma, director of the Clinical Immunology and Vaccineology Unit of the Roman hospital, studied the application of a diagnostic procedure to characterize at the molecular level the viral residue within the infected cells of adolescents and young adults born with HIV (inherited from the mother via vertical transmission), which made it possible to understand whether the virus is dormant (i.e. inactive) or still capable of rapidly multiplying in case of interruption of therapy. This procedure is called leukapheresis and consists in taking only the white blood cells using a special machine, including the Cd4 cells, present in the T lymphocytes, which host the residual amount of virus.

A sleeping virus

“It is a blood filtering technique that allows only infected cells to be collected and all the other blood components to be reintroduced into the patient’s body – explains Palma -. Indeed, it would be impossible to study the characteristics of the virus in people under therapy from birth, which therefore have a very low frequency of infected cells, through a standard peripheral venipuncture because it would require the withdrawal of large quantities of blood”. The criteria for selecting the candidates of the study are: «Started treatment at an early stage, i.e. within six months of birth, demonstrated efficacy of therapy maintenance and absence of viral load detectable in the blood» Palma describes. “At the moment – ​​continues the doctor – we have tested this approach on nine subjects aged between 13 and 25 years being treated in our hospital and five of these boys have virological characteristics for which they could interrupt the therapy without any risk. In 2023 we will extend the investigation to another 60 patients. We expect to experience approx 5% of cases with dormant virus for which it will be possible to suspend the treatment».

Therapy or vaccine

The results of the study will be presented during the thirtieth edition of the «Conference on retroviruses and opportunistic infections», which will be held from 19 to 23 February 2023 in Seattle. «The purpose of this survey is not so much to apply the procedure developed to all candidates, but rather understand why some patients are unable to control viral replication without having to take care. If we find this out, we can identify it immunologically based therapy or a vaccine that it is able to replicate these protective responses in such a way that for the rest of life the person is not forced to take antiretroviral drugs» says Palma. The World Health Organization estimates worldwide 1.8 million children between 0 and 14 years affected by HIV and about 150,000 new infections in children each year. In Italy in 2021, according to the latest data from the Higher Institute of Health, they registered two new cases between 0 and 2 years.

Side effects

“If the mother follows adequate therapy, she does not transmit the infection to the fetus,” she underlines Luisa Galli, Head of Infectious Diseases at the Meyer Children’s Hospital in Florence and coordinator of the National Register for HIV infection in pediatrics —. The study of the Child Jesus is very interesting and very promising, because one of the problems at present is that in case of suspension of therapy the virus begins to replicate and causes immunodeficiency. Giving patients who have a residual viral load the opportunity to discontinue drug therapy allows them to have a better quality of life and to eliminate side effects in the long run of therapy, as well as saving money for the National Health Service». Mastroianni concludes: «It is a basic experimental research, useful for understanding the mechanisms of infection control in the absence of antiretroviral therapy in particular conditions and for exploring the possibility of future plans to completely eradicate the infection from the body».