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Testimony "Doctors tell me over and over again that I'm cured"
Chronic SuperVIHvientes: the generation that has been living with the AIDS virus for 30 years
The Hospital Clínic-Idibaps in Barcelona presented today at the AIDS 2022 World Conference in Montreal, Canada,
an exceptional case of functional cure of human immunodeficiency virus (HIV) infection
, the agent that causes AIDS.
This is a patient,
an adult woman
, who after stopping antiretroviral treatment 15 years ago has maintained absolute autonomous control of HIV replication, which she still carries with her but in an undetectable volume (viral load).
Until now,
other post-treatment controllers
have been described, such as this patient from Barcelona, but none with absolute control in such a long term as her (15 years);
the usual is days or months.
Elite
controllers
(have defective viruses or genetic factors associated with a potent immune response to HIV from a type of lymphocyte, CD8+ T cells) and
patients (known as
Berlin
,
London
and Düsseldorf)
cured after, due to of leukemia, having received cells from an adult donor - bone marrow and blood stem cells - with a protective mutation.
The communication of the exceptional case of Barcelona at the world congress was led
by Núria Climent, a researcher from the AIDS and HIV infection group at Idibaps
, directed by Josep Mallolas, head of the HIV Unit at the Clínic, from the AIDS and HIV infection research group. IDIBAPS HIV and professor at the Department of Medicine at the University of Barcelona (UB);
Josep Maria Miró, specialist in infectious diseases at the Hospital Clínic, head of the Idibaps group and professor of Medicine at the UB;
Juan Ambrosioni, doctor of the HIV Unit of the Hospital Clínic and researcher of the AIDS and HIV Infection group of the Idibaps, and Sonsoles Sánchez-Palomino, researcher of the same group.
All of them are
researchers of the CIBER of Infectious Diseases (CIBERINFEC).
Other researchers from the Clínic-Idibaps, the UB, the CIBERINFEC, the Germans Trias i Pujol Hospital in Badalona and the IrsiCaixa and the Carlos III Health Institute have participated in the follow-up of the case and its study.
As reported by the Clínic-Idibaps team, at a press conference in Barcelona prior to the world congress,
advances in therapies have made the disease chronic and improve the quality of life of infected people
, but, although antiretroviral treatment is effective to suppress viral replication, HIV persists in body reservoirs and, if therapy is stopped, rebounds.
Being a post-treatment controller
implies that, as happens in other viral infections, despite the fact that
the virus is not completely eliminated from the body
, the person's immune system is capable of
controlling it without the need for drugs
.
Along with the description of the case, the Clínic/Idibaps team presents its study at the AIDS 2022 Congress, in which it describes the particular immunological mechanisms of the patient.
The woman, who wishes to remain anonymous, was diagnosed in the stage of acute HIV infection and was
included in a clinical trial with antiretroviral treatment for 9 months
and also with various immunomodulatory interventions with cyclosporine A, which is an immunosuppressant, during the first 8 weeks
The
patient did not have classical genetic factors associated with HIV control
and, moreover, presented a severe primary infection, something that is not common in post-treatment controllers or in elite controllers.
On the other hand, it has been verified that the patient is not infected by defective viruses, that is,
her viruses are viable because they have been able to be isolated and cultivated
without any problem in the laboratory.
"Over these years we have found a pronounced and progressive drop in the number of viruses in the reservoir, which suggests
control by the immune response
," explained Sanchez-Palomino.
The researchers discovered from this suspicion that
the patient's blood cells are highly resistant to being infected by the HIV virus in
in vitro culture, but that her purified CD4+ T cells are susceptible to HIV infection.
This told them that
other cell populations in the blood may be blocking infection
and may be contributing to the control of HIV.
'Natural killer' cells and CD8+ T lymphocytes, the key to healing
Through a test, they observed that there is
a strong inhibition of HIV promoted by two types of lymphocytes
:
'natural killer' cells
, which are part of the innate immune system and constitute the first line of defense against different pathogens, and
CD8+ T lymphocytes
, They play a key role in defending cells against viruses and bacteria.
"The great novelty of the work is that
we have characterized the cells that gain control of the virus
", pointed out Núria Climent.
According to the team, these cells are responsible for what is called the innate response and correspond to
NK memory cells, from English 'natural killer'
, and cytotoxic T lymphocytes, so named because they are responsible for eliminating other cells.
"The patient has
very high levels of the two cells, which could block the virus or destroy the infected cells,
thus achieving functional healing," Climent said.
The team, which after the presentation of this exceptional case at the world congress will continue with the investigation at least to study the patient's genetics,
believes that the case opens the door to finding a way for all infected people to have a volume important number of
'natural kiler' cells and cytotoxic T lymphocytes and, furthermore, of high quality.
Although it is also pending to find out if in other patients treated with antiretroviral plus cyclosporine A what happened
in this woman, who was diagnosed and treated just when she was in the acute phase of the disease,
would be replicated or not .
If so, generalizing this treatment to all, or a large part, of patients with HIV would allow them to go years without medication.
This
option to try to put an end to the pandemic on a large scale
- we must bear in mind that a person with an undetectable viral load cannot transmit the infection to others (sexually) - is, in the opinion of the Clínic/Idibaps team, more realistic than subjecting them all to bone marrow transplants.
To achieve this, in addition to verifying whether this hypothesis is true,
it would also be necessary to intensify the early diagnosis of HIV infection
.
"Functional cure of HIV
is a much more realistic goal on a larger scale than sterilizing cure
(bone marrow transplant), which is why it is so important to understand the underlying mechanisms," Ambrosioni added.
Also participating in the communication at the congress were: José Alcamí, Monserrat Plana, Tania González, and Cristina Xufré, from the Clínic-Idibaps group and CIBERINFEC, and Roger Paredes, Marc Noguera and Maria Casadellà, from the Germans Trias i Pujol Hospital in Barcelona and the IrsiCaixa.
Objective: living with HIV without taking medication
Chronic
treatment with a combination of antiretrovirals makes it possible to prevent the progression of AIDS
in most cases, but it does not eradicate HIV infection, it entails a very high economic cost and can cause toxicity.
Furthermore, if treatment is abandoned, the virus 'comes back' within a few weeks.
According to information from the AIDS Research Institute (IrsiCaixa) of Badalona, in Barcelona
, one of the main objectives of current research is to ensure that people living with HIV can stop taking medication,
which can be achieved in two ways: eradicating the virus from the body or achieving the so-called functional cure.
At IrsiCaixa they are working on this line of research through the study of various strategies that could be combined: therapeutic vaccines (for infected people), antibodies, drugs that reactivate the latent virus, etc.
To achieve functional healing, at IrsiCaixa, they study "
the activity of HIV in the reservoirs, which are the cells of the body where the virus remains dormant and awakens when the infected person stops taking the treatment
. While the cell remains inactive, the viral reservoir is invisible to the immune system and antiretroviral therapy, which is unable to detect and eliminate it. The reservoir is the reason why treatment must be taken for life today, and find a way to identify it, activate it and destroying it would be a definitive step towards eradicating HIV."
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