Argentinian woman reportedly cured of HIV by natural immunity

RIO DE JANEIRO, BRAZIL – The woman is known to reside in the city of Esperanza, in the central-eastern province of Santa Fe. Researchers have nicknamed her the ” Hope ” patient because of her place of origin and the significance of the scientific finding, researchers have nicknamed her the “Hope” patient.

The woman is a mother, 30 years old, and was first diagnosed with HIV in 2013. “I enjoy being healthy,” Esperanza’s patient, who spoke on condition of anonymity because of the stigma associated with the virus, told NBC News in Spanish via email. “I have a healthy family. I don’t have to medicate myself, and I live as if nothing happened. This is already a privilege.”

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Co-authors of the study, which was published Monday in the scientific journal Annals of Internal Medicine, said they believe their findings will indeed bring hope to the 38 million people, according to U.N. data, living with the virus worldwide. To the ever-expanding field of HIV cure research. . The case serves as one of two proofs of concept that a so-called sterilizing cure for the virus is possible through natural immunity.

“This is the miracle of the human immune system that did it,” said Xu Yu, Ph.D., a viral immunologist at the Ragon Institute, Boston, who in partnership with Ph. Natalia Laufer, a medical scientist at the INBIRS Institute in Buenos Aires, led the exhaustive search for any viable HIV in the woman’s body.

“Now we have to figure out the mechanisms,” said Steven Deeks, M.D., a leading HIV cure researcher at the University of California, San Francisco, who was not involved in the study. “How did this happen, and how can we recapitulate this therapeutically around the world?”

Scientists are pursuing the Herculean task of curing HIV on multiple fronts, including through gene therapy. Those efforts attempt to eliminate the virus from its so-called reservoir or keep it trapped in cells; and therapeutic vaccines that would enhance the body’s immune response to the virus.

To date, researchers have successfully cured two other people therapeutically, in both cases, through complex and dangerous stem cell transplants.

HIV has proven extraordinarily difficult to eradicate from the body because it infects specific long-lived immune cells, collectively known as the viral reservoir, which can spend prolonged periods in a quiescent state. This keeps the viral DNA, known as a provirus, encoded in those cells under the radar of standard antiretroviral treatment, which can only attack the virus in infected cells when they are actively producing new copies of HIV.

Yu was also the lead author of a paper published in Nature in August 2020 that looked at 64 people who, like the Argentine woman, are so-called elite HIV controllers. These are among the 1 in 200 people with HIV whose own immune system can somehow suppress virus replication to very low levels without antiretrovirals.

The authors of that study found that the immune systems of these individuals appeared to have preferentially destroyed cells harboring HIV capable of producing viable new copies of the virus. Only infected cells remained in which the viral genetic code was spliced into a kind of genetic dead zone: regions of cellular DNA that were too far away from the levers that drive viral replication.

One member of that cohort, Loreen Willenberg, a Californian who is now 67 and was diagnosed with HIV in 1992, stood out as having an immune system that had beaten the virus thoroughly. Even after sequencing billions of her cells, scientists could not find any intact viral sequences.

According to Yu, Willenberg’s case of an apparent natural cure for HIV is quite similar to that of Esperanza’s patient. The virologist estimated that each of these women may have mounted a particularly potent killer T-cell response to the virus, a full-court immune press that researchers could one day recapitulate therapeutically.

“I’m looking forward to learning more about this seemingly new phenomenon of extraordinary elite control” of HIV, said Rowena Johnston, director of research at amfAR: The Foundation for AIDS Research, about how the two women’s cases have inspired her. “There’s a lot to know.”

After Esperanza’s patient began partnering with Yu’s team in 2019, scientists intensively searched for viable HIV in 1.2 billion of her blood cells. NBC News reported that they also recorded 500 million placental tissue cells after the woman gave birth to an HIV-negative baby in March 2020.

Using highly sophisticated and sensitive genetic sequencing techniques that have only recently become available, Yu and his team once again found no intact viral sequences in the elite driver they were studying.

“The study sets the standard for demonstrating that Esperanza’s patient does not have replication-competent proviral DNA inside her cells,” said Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, a division of the U.S. National Institutes of Health, which funded the study along with the Bill & Melinda Gates Foundation. “The more of these patients we discover and work with, the more complete our understanding of what a cured patient looks like.”

A person diagnosed with HIV would generally be considered functionally cured if they retained viral DNA in their cells that could give rise to new viable copies of the virus. Still, nevertheless, some sustained strength remained indefinitely suppressed without antiretroviral treatment.

This scenario is also sometimes referred to as post-treatment HIV control or viral remission. Several documented cases of people who have discontinued antiretroviral treatment, mainly if they started such therapy very soon after contracting the virus, have not seen their viral load recover for years.

IN A STERILIZING CURE, THERE WOULD BE NO VIABLE HIV ANYWHERE IN THE BODY

“We’re never going to be 100 percent sure that there is absolutely no intact virus, no functional virus anywhere in their body,” Yu said of Esperanza’s patient. “Bringing what we learn from these patients to a broader patient population is our ultimate goal.”

Also inspiring the field of HIV cure research are the cases of two men in whom researchers succeeded in pushing sterilizing cures: American Timothy Ray Brown and London resident Adam Castillejo. The men received stem cell transplants to treat acute myeloid leukemia and Hodgkin’s lymphoma, respectively, from donors with a rare genetic abnormality that made their immune cells resistant to HIV.

Ravindra K. Gupta of the University of Cambridge, who is the lead author of Castillejo’s case study, said that after more than four years since Castillejo’s stem cell treatment with no signs of a resurgent virus, the doctor was now ready to state for the first time in time that the British man was almost definitely, rather than probably, cured of HIV.

In 2019, Björn Jensen of Düsseldorf University Hospital presented the case of a third man, known as the Düsseldorf patient, whom the German doctor and his colleagues attested had probably also been cured by this method. Jensen told NBC News that this man has yet to experience a viral rebound three years after stopping his antiretroviral treatment.

While these three cases have caused a stir, the treatment the men received is too toxic to attempt to cure HIV in anyone who is not facing treatable cancer with a stem cell transplant. Since Brown’s case was first published in the New England Journal of Medicine in 2009, scientists have failed to cure HIV in people by similar means on other occasions.

Brown died in Palm Springs, California, in September 2020 after his leukemia returned. He was 54 years old. He spent the last chapter of his life enthusiastically championing the field of research that his landmark case study had primarily catalyzed.

According to Mitchell Warren, executive director of the HIV nonprofit AVAC, public and nonprofit investment in HIV cure research in the U.S. reached about $335 million globally in 2020, up from $88 million in 2012. The lion’s share comes from the NIH.

Pharmaceutical companies such as Gilead Sciences and ViiV Healthcare are also investing in the search for a cure for a virus that has killed some 36 million people worldwide over the past four decades.

With information from Infobae