Harvard scientists identify second HIV patient whose body appears to have shed the virus

They wanted to do the same with her placenta because even though it is an organ of the fetus, it is loaded with maternal immune cells – an environment rich in targets for stealth viruses to exploit.

Like scientists reported Monday in Annals of Internal Medicine, they found none. This means that the woman, whom they call “Esperanza’s patient” to protect her privacy, appears to have eradicated the deadly virus from her body without the aid of drugs or a bone marrow transplant – which would do. of her only the second person suspected of being recovered from HIV.

“This gives us hope that the human immune system is strong enough to control HIV and eliminate all functional viruses,” said Dr. Xu Yu, immunologist at the Ragon Institute of Mass General, Massachusetts Institute of Technology and Harvard. and main author. on the new report. “Time will tell, but we believe she has reached a sterilizing cure.”

The discovery, which was previously announced at the Conference on Retroviruses and Opportunistic Infections in March, could help identify possible treatments, the researchers said.

About a decade after the start of the AIDS pandemic, doctors began to find a handful of patients who tested positive for the HIV virus but had no symptoms and were subsequently found to have extremely low levels of the virus in their bodies. body. At the time, these case studies were supposed to be ad hoc.

But the more the doctors looked, the more they discovered such patients. The past decades have revealed that people with exceptionally strong immune responses constitute about 0.5 percent of the 38 million people infected with HIV on the planet. Scientists call these people “elite controllers” and in recent years they have become the subject of intense international study.

In a patient Yu examined with Dr. Steven Deeks, a longtime HIV researcher and professor of medicine at the University of California, San Francisco, researchers found no intact viruses in more than 1.5 billion of its cells. Loreen Willenberg, a 67-year-old Californian, had maintained control of the virus for nearly three decades without using antiretroviral drugs. If Esperanza’s patient is the second person known to have been naturally cured of HIV, Willenberg is the first.

Their bodies could be a model of a cure for HIV; if researchers can figure out what makes elite controllers special, perhaps they could incorporate it into drugs, gene therapies, or other one-off treatments that could free millions of people from a lifetime of taking. antiretroviral drugs. They might even find ways to boost the immune system of non-responders – people whose natural defenses have been so damaged by HIV that they are hypersensitive to a host of other health problems.

One of HIV’s dirtiest tricks is that when it enters a cell – usually a T cell or other immune cell – it makes a copy of the DNA of itself that fits into the genome of this cell. So when this cell’s protein-making machinery encounters this piece of viral code, it unintentionally builds more copies of the invading HIV. Antiretroviral drugs disrupt this process, giving patients’ immune systems time to find and kill these hijacked cell factories. But some DNA copies of the viral plane persist. In theory, they could wake up and start creating a virus at any time.

This is why people have to take antiretroviral drugs for life and why they can never be cured; doctors have no way of attacking or annihilating these latent integrated genomes of HIV. And until recently, there weren’t even any good methods to detect them. But Yu’s group has been at the forefront of developing ways that scientists can open billions of immune cells and sort their DNA for the smoldering remains of past infections.

Deeks said he was very curious to find out more about what happened in the first days and weeks after Esperanza’s patient was infected. For some reason, her body did not develop antibodies against all of the different HIV proteins one would expect. This suggests that its natural defenses quickly put the brakes on viral replication, before the virus spreads and overwhelms its immune system. Usually this only happens if someone starts antiretroviral drugs very early.

It can be a bit difficult to study what happened in someone’s body almost ten years ago. Many players in the immune system are transient molecules, and digging up evidence for them now can be nearly impossible – like trying to find a jellyfish or flatworm fossil. But Deeks said comparing his DNA or gene expression in immune cells to that of other patients might reveal something interesting.

These are the types of analyzes that Yu’s group is currently working on, together with patient Esperanza’s doctor, Dr Natalia Laufer, HIV researcher at El Instituto de Investigaciones Biomédicas en Retrovirus y SIDA in Buenos Aires who studies the elite controllers.

In an email, Esperanza’s patient told STAT that she doesn’t feel special, but rather blessed for the way the virus behaves in her body. “Just thinking that my condition could help cure this virus makes me feel a great responsibility and a great commitment to make it a reality,” she wrote. Her first child is healthy and HIV-free, and she and her partner are now expecting a second, said the woman, who declined to be named.

Laufer calls this a “beautiful coincidence” which Esperanza translates as “hope”.

“That individuals can be cured on their own is a shift in the HIV paradigm,” said Laufer. She added, however, that they may never be able to say “cure” for sure, as that would require the impossible task of sequencing every single patient’s cell. But, said Laufer, “We are seeing indications that it is possible for some people to fully control HIV infection. And it’s very, very different from what we thought 40 years ago.

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