A Spanish woman with HIV has spontaneously controlled the virus to undetectable levels for more than 15 years without taking medication. The news seems simple to state, but the consequences are enormous. Especially because as Josep Mallolas pointed out, head of the HIV-AIDS unit at the Barcelona clinic, “were able to discover what is the possible mechanism that allows this”. And that brings us decisively closer to a working cure for AIDS.
What do we know about the case? Although full details of the case will be presented this week at the 24th International AIDS Conference in Montreal, the Hospital Clínic team gave a press conference to announce what they defined as a “unique ” and “exceptional” functional cure of a disease that affects more than 37 million people worldwide.
For what they explained, the “Barcelona patient” (whose identity is naturally kept anonymous) was diagnosed in 2006. She was then selected for a clinical trial which used certain immunomodulatory treatments (such as cilosporin A) to complement the effect of antiretrovirals and boost the immune system. Nine months were enough for the patient to reduce her blood viral load to “undetectable”. 15 years and 50 analyzes later, despite not taking medication, the burden has remained the same.
Why is this relevant? Diseases are complex relational phenomena, and if we study them case by case, we find striking things which, in short, have more to do with the particular case than with something that we can use against the said disease. With the “Barcelona patient”, for a long time, the researchers believed who were in this situation. She was the only participant of the 20 people who received this treatment who reacted in this way.
In reality, when they studied the bone CD4+ T cells (despite being the main targets of the virus) of the patient, they found no significant difference. After much thought, they discovered that the key was not in the CD4+, but in NK cells (“Natural Killer” or “natural killers”) and in CD8+ T cells.
What implications does this have? The team didn’t stop there, of course. She was able to determine which types of NK and CD8+ cells are responsible for this very effective marking of HIV. That is to say, they were able to identify the mechanism by which the immune system was able to control the infection and this opens up a huge avenue to progress towards a functional cure for AIDS.
Functionality is important. As the researchers noted, what the patient does is control the replication of the patient’s HIV without the need for treatment. To say it more or lessthe patient has her own natural antiretroviral drugs, but the infection is still there (the CD4+ cells continue to retain their ability to replicate the virus intact)
Next? Is it really that important? The truth is yes. Until now, the means we had to “cure” the disease they required treatments so aggressive, complex and expensive that they made massive treatment impossible. If the Clinic researchers are right and we learn to activate this control mechanism, the situation will change dramatically. There is still a lot of work to do, but today is a good day to celebrate hope.
Picture | Clinical