The HIV puzzle is complicated by the patients who control the virus: "At the moment they are only the exception that confirms the rule"

• Controlling AIDS A woman from Barcelona, ​​the world's first case of HIV control without treatment for 15 years

• First case The curious case of the man who beat HIV in 2008

• Previous Cases A second patient is cured of HIV and another in long-term remission

If, in the eyes of public opinion, the case of the patient from Barcelona who, after stopping antiretroviral treatment

in her body, has been received with enthusiasm, the experts in HIV, mostly gathered at the World AIDS 2022 Conference in Montreal, Canada, are little surprised and rather cautious.

Javier Martínez-Picado

, ICREA researcher at the AIDS Research Institute (IrsiCaixa) in Badalona, ​​Barcelona, ​​who has spoken today at the world conference and, to questions from EL MUNDO, has stated that, despite the fact that the details of the case of women in Barcelona, ​​reported by the Hospital Clínic-Idibaps,

The exceptional nature of this patient, and others who naturally or through medical intervention have managed to control or eliminate the virus from her body,

."

This virus is much more complex than the SARS-CoV-2 that causes Covid-19 because it gets into the DNA of the cells and does not come out of there if it is not killing the cell itself, she has recalled.

How many types of controlling patients are there?

HIV infection, the causative agent of AIDS, is extremely difficult to cure.

Martínez-Picado has explained that there are only

.

Specifically, in stem cell transplants (one in Berlin, one in London, one in Dusseldorf, which has not yet been published, and another in New York) because they suffered from lymphoma or leukemia.

For them

;

not everyone is worth

This type of transplant, highlights the IrsiCaixa expert, is risky -with a 40% mortality- and, although due to its complexity it cannot be scaled to many patients,

Fifth elite controller case filed in Montreal: City of Hope

This is a 66-year-old man, so he could be, if the above data is confirmed, the oldest person cured of HIV through a cell transplant.

As reported by the medical team, headed by Jana K. Dickter, a professor in the Division of Infectious Diseases at the City of Hope, in Los Angeles, the patient was diagnosed with HIV in 1988.

He has been in remission from the virus for more than 17 months after stopping antiretroviral therapy after receiving a bone marrow transplant that treated leukemia.

Again, the grafted donor cells had the specific mutation that confers resistance to HIV.

Another group, he points out, are all those

and, despite this, neither have the virus in their body nor have they become ill.

there is even a subgroup within them called the exceptional elite controllers, who have not had signs of the virus in their body for more than 25 years, although they do show signs that at some point they had it, but their system immunologist reacted well and, thanks to that, they live a healthy life.

In between the two previous groups are the post-treatment controllers,

, Martínez-Picado has remarked.

This treatment is maintained for a while and, due to the health system they have in the US, they are withdrawn (in Spain this does not happen) and this is what has made it possible to identify people who, after stopping antiretrovirals, have continued to control the virus without medication.

In that group is the so-called Visconti cohort

, a group of 14 patients who started antiretroviral therapy in the first 10 weeks after infection but abandoned it about three years later on average and who have maintained an undetectable viral load without treatment.

The people in this cohort have, like the woman from Barcelona, ​​a type of

that is especially active and forms part of the innate immune response.

Despite their lack of specificity, one of the advantages of these cells is that they cannot be infected by HIV.

Martínez-Picazo has also contributed a series, which has already been published in

, of

, respectively, and who continue to have undetectable virus in their blood, despite never having taken antiretrovirals.

Scientists have investigated what genetic, immune and viral factors have led to this situation, known as functional cure, which is how the Barcelona patient at the Hospital Clínic-Idibaps has also been defined.

The study of these three cases is led by IrsiCaixa itself

with researchers from the Microbiology Center of the Carlos III Health Institute in Madrid (ISCIII) and the Infectious Diseases Unit of the Virgen del Rocío University Hospital/Seville Institute of Biomedicine (IBIS).

The Sandoval Health Center of the San Carlos Clinical Hospital in Madrid has also collaborated.

All these laboratories belong to the AIDS Research Network (RIS) of the RETICS of the ISCIII.

All these cases and groups, declares Martínez-Picado,

, ​​and "they are important in themselves. The one that the Clínic-Idibaps announced yesterday (at the world conference) is important and joins others who are too".

Skepticism about driver applications

"There are people who have the capacity to control the virus and

, as well as making it affordable for all affected patients in the world, but it will be achieved. Everything we learn from them will be valid for the future", he highlights.

Along the same lines,

, a professor at UNIR, admits that the discovery of Barcelona

but considers that "it is a interesting case, but no more than that".

"It is interesting as a proof of concept

this can happen. But HIV is a very well known disease, there is a lot of research and this is more than exceptional and

. Well, for the 37 million people infected with HIV, the strategy that we can use is not going to be that. It is going to be an antiviral treatment, gene editing or other types of strategies," he adds.

Regarding the possibility that this case will lead to a new line of investigation, the HIV expert states: "Of course, immunotherapy techniques can be investigated, which could complement the action of antiretroviral treatment and,

".

In this statement, the expert does not convey a clear enthusiasm.

Josep Maria Gatell

, an international benchmark in AIDS (former head of the Infectious Diseases and AIDS Service at Hospital Clínic de Barcelona, ​​from which he retired four years ago, and currently senior global medical director at ViiV Healthcare, a company for the development of drugs against HIV of the GlaxoSmithKline group), comments with EL MUNDO when he is about to travel to attend the world conference in Montreal, that

He explains that throughout the AIDS pandemic, exceptional cases have been described for one reason or another.

It highlights, for example, the case of the woman from Esperanza, in Argentina, linked to mechanisms different from those communicated yesterday about the patient from Barcelona.

The

(it was published in the

), also excited patients who follow antiretroviral treatment because she could give the scientific community a clue to ensure that they could live without medicate

That Argentine, now about 31 years old, was diagnosed with HIV infection in 2013.

a person who can control viral replication below detection limits without antiretroviral therapy.

She, unlike the patient from Barcelona, ​​did not take this type of medication nor did she undergo a bone marrow transplant.

And before her, there was another person, also a woman, who was cured only thanks to her immune system: Loreen Willenberg, 67, from San Francisco, in the United States;

Her case was published in Nature in 2020. She was diagnosed in 1992 and 18 years later she was considered the first person in the world to be cured without a bone marrow transplant or medication.

Gatell indicates that

and almost all of them are the subject of high-level publications or conference presentations and media attention for the simple reason that "they are exceptional."

And he sentences that: "When they began to know each other, it was thought that we would

The long-term elite controllers each present a different mechanism. That the woman from Barcelona, ​​as has been made public ( I don't know the case in detail), having a higher volume of natural killer cells and CD8+ T lymphocytes in the blood is a personal trait from birth that allows her to control the virus.

" .

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