Spanish woman revives hope of finding a cure for HIV / AIDS

A Spanish woman has revived hopes of finding a cure for HIV / AIDS having effectively managed her infection for more than 15 years with treatment.

Hospital Clínic de Barcelona and the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) released a report on Monday, August 1 that said that she has managed to keep her infection under control and without medication for longer than anyone else in the world.

The Clinic and the Institute, who have been working with the unnamed woman since she was first diagnosed, said that they have identified a mechanism by which her immune system efficiently fights the infection.

Considered a functional cure, her case has revived hopes of developing an effective treatment for patients worldwide.

HIV AISA patients are currently treated with retrovirals that manage the concentration of the virus in the body, which they do by preventing it from replicating. Patients are, however, never cured and remain on the retrovirals for life.

Currently, anyone who stops taking the drugs experiences a massive relapse with pools of dormant virus cells being regenerated and replicating once again.

With nearly three out of every 10 contracting the virus through heterosexual contact, new cases still continue to be diagnosed. But, there are also those cases where the body is able to keep the virus at bay either without assistance or through bone marrow transplants.

Some viruses are defective and are not able to protect themselves against the body’s immune system.

In addition to the so-called elite controllers there is a small percentage who after stopping retrovirals, are able to control the virus for months and even years.

But there is no known cure per se.

The Barcelona woman’s case is different as she does not fit into any of the above categories. Diagnosed when she needed to be hospitalised, she participated in a clinical trial that involved the use of the immunosuppressant drug, cyclosporine A.

She took the drug for the first eight weeks. Once she came off the treatment she managed to continue to control the infection and has now done so for 15 years.

Núria Climent, a Researcher in the AIDS and HIV infection group at IDIBAPS said: “The woman was treated with antiretrovirals and an immunomodulatory treatment, and once the treatment stopped, she managed to control the virus on her own.

“And it is surprising because she has been doing it for more than 15 years.

“Over time, moreover, we have seen a pronounced and progressive drop in the viral reservoir, which suggests the important role that the immune system is playing.”

Presenting the case at the AIDS 2022 World Conference in Montreal, Canada, the clinic and the institute said they decided to investigate the reasons.

The first step in the experiment was to look at the CD4 lymphocytes, the main target of HIV. They exposed hers to the virus and although they became infected they were inhibited.

That gave researchers a clue as to where the solution may lie.

Climent said: “We characterised these cells, which are special cells of innate immunity: natural killers and CD8+ gamma alpha T lymphocytes. And it is these two cell subtypes that seem to control the virus in this patient. And that is a new mechanism that we have discovered.”

Josep Mallolas, Head of the AIDS and HIV infection group at IDIBAPS and head of the HIV unit at Hospital Clínic said: “It opens a new avenue to develop strategies that are either able to emulate the activity or enhance the activity of these cells involved in the innate response of the patient so that more people can benefit from this functional cure without treatment.

“It opens up a new avenue for developing strategies from which more people can benefit.”

The woman concerned still has the virus in her body but she cannot transmit it and the amount is undetectable. There are other factors that are being looked at including the woman’s age, with more women contracting the virus than men.

So far three patients are said to have been cured of HIV AIDS, a Berlin patient, who was the first to be reported, a London patient and a Düsseldorf patient. In all three cases, the men were HIV-positive and had developed leukaemia.

That necessitated a bone marrow stem cell transplant, a high-risk procedure that is the last resort for HIV patients and therefore is not considered an option for most HIV-positive people.

A functional cure is now more realistic with the Spanish woman reviving hopes of a HIV / AIDS cure.

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