More than 15 years without HIV and without drugs: a functional cure of AIDS may be in sight

The human immunodeficiency virus (HIV) plagues many lives and, once it arrives, it gives the immune system no respite. Although this is the standard, in Barcelona, ​​a patient is surprising researchers, having been without the virus for more than 15 years, without resorting to any medication.

Is this a new path to a potential cure?

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It is not a new virus and caused a wave of prejudice and discrimination that haunted the 1980s. Although HIV infection is not linearly associated with the development of AIDS, the madness of the time led to a lot of misinformation about the disease.
If at the time it was highly associated with certain lifestyles and sexual orientations, today it infects almost 38 million people, the story is significantly different – ​​although much remains to be clarified.
The search for a cure that frees those infected from this virus that attacks and destroys the defense mechanisms that protect human beings from diseases has been incessant.  However, although there is progress and surprising news that renew hope, the truth is that there is still no cure, there is only a way to suppress the virus and delay the evolution of the disease.
O The Country states that the four decades of scientific advances have saved millions of infected people, through antiretroviral therapy (ARV) - a series of drugs that prevents the virus from reproducing to the point of making the viral load undetectable and, consequently, making it intransmissible - , which allows a normal and quality life to more than 28 million people.
Although the current solution is not ideal, it is cases like that of the patient in Barcelona that intrigue researchers and motivate them to understand how to definitively turn HIV around.  The study was carried out by a team led by doctors from the Hospital Clinic Barcelona and the results will be presented in the 24th International AIDS Conferencein Montreal, Canada, this week.

More than 15 years without HIV without using drugs
A Spanish woman, whose personal data has been withheld to ensure anonymity, has had an undetectable viral load for more than 15 years, without taking medication.  In a case that the researchers describe as “unique” and “exceptional”, according to El País, the patient may represent the beginning of the discovery of a functional cure for the disease.

This woman has been off medication for over 15 years.  After a short period of time, she totally controlled the AIDS virus and this has a very important aspect: we managed to discover what is the possible mechanism that allows it.

revealed Josep Mallolashead of the HIV-AIDS Unit at Hospital Clínic Barcelona, ​​during a press conference.

Josep Mallolas, Head of the HIV-AIDS Unit at Hospital Clínic Barcelona

A patient from Barcelona was diagnosed in 2006 with an acute infection that is not typical in either of the two groups of rare exceptions when it comes to HIV: some people are called “post-treatment controllers” because they keep away from the treatment. virus after stopping the medication;  and others are the “elite controllers” who achieve the same without initiating antiretroviral therapy.
As revealed by El País, the patient was included in a trial conducted by José M. Miró, in order to see if the immune system could be stimulated to control the reproduction of the virus.  From a sample of patients, one part received only antiretrovirals and the other received a set of additional immunomodulatory treatments.

Nine months after stopping treatment, this patient no longer had a detectable HIV viral load in her plasma.
The virus has not recovered, and has not recovered for 15 years and over 50 viral load tests;  it's not that sometimes I can't have a little low-level presence.  It has always been undetectable.

Clarified Núria Climent, researcher at the research group on AIDS and HIV infection at the Pi i Sunyer Biomedical Research Institute (IDIBAPS), during an interview given by the medical team to El País.
The patient from Barcelona was the only one of 20 individuals to react in the way described by the doctors.

Patient response opens new doors to HIV cure
After discovering the patient's immune response, the doctors infected the main target of HIV, CD4+ T cells.  With this, they verified that they were able to replicate the virus, so the problem was not in the entry of the virus into the cells.
However, when they cultured subpopulations of blood cells, they found that there was a very strong control of virus replication.

This suggested that these other subpopulations were involved.  With in vitro tests we showed that they were the so-called Natural Killer cells [NK] and also CD8+ T lymphocytes.

One of the team's doctors, Sonsoles Sánchez-Palomino, explained to El País.


Our body uses NK cells to trigger an immune reaction when it comes into contact with the AIDS virus and, if they are potent, they can control it.



It is as if we are witnessing for the first time the undisputed victory of the immune system over the virus.

Celebrated the doctor Josep Mallolas.

Viruses can have their years numbered
According to El País, this investigation is important because it characterizes the subpopulations of NK cells and which subpopulations of CD8+ T lymphocytes could be involved: NK cells, which have memory, and Gamma-Delta T cells, which provide natural immunity.  As Climent describes, “the patient has very high levels of both, and they may be blocking or destroying those that are infected.”

If we could, through treatment, repeat or replicate the natural immune capacity that this woman has, the advantages would be enormous.

Said Josep Mallolas.

From left to right: Josep M. Miró, Juan Ambrosioni, Sonsoles Sánchez-Palomino, Núria Climent, Josep Mallolas and José Alcamí

Although impressive, the researchers point out that the patient from Barcelona differs from the patients from London and Berlin, since, in her case, despite having a functional cure - controlling the replication of HIV without treatment -, the cells have a viable virus. to cause new infections.  The other two, in turn, were able to cleanse their bodies through a bone marrow transplant.

You cannot use it for the nearly 40 million people with HIV.  On the other hand, if you manage to detect a group with a certain genetic material that, through certain interventions, can spontaneously control the virus, you will be doing something potentially much easier to expand.

The team is already planning the next steps.  In the voice of Mallolas:

What is very important is to study this woman in depth and, once we know her cells and her 100% immunity, we will be able to design research projects for other people, so that even if we cannot cure them, we can ensure that they can remain untreated, with an undetectable viral load and without the possibility of infection for many years.  This opens up a fascinating array of research possibilities.

According to the researchers, at best, the team will be able to find a definitive cure.  On the other hand, in the worst case, the patient who has been a “super collaborator” and has given “everything for science” could need to return to antiretroviral treatment.

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