HIV 3D Illustration
A handful of patients have had an extraordinary opportunity: to be cured of an HIV infection, the origin of AIDS. But these cases are extremely isolated and do not yet allow the development of treatments that would lead to the complete elimination of the virus.
I never imagined I would live long enough to be HIV-free, sums up one of these patients, whose recovery was announced on Wednesday, shortly before the International AIDS Conference, an important meeting which is being held this year in Montreal.
This patient, who wishes to remain anonymous, but who spoke in a press release from the California hospital where he was treated is the fourth or fifth to be cured of HIV, according to different counts.
These cases are therefore very rare. They must be distinguished from the millions of patients infected with HIV, but who can count on a normal life expectancy thanks to the existence of effective treatments.
These treatments, called antiretrovirals, block the reproduction of HIV in the body, but they do not eliminate it completely. However, in the few cases of proven cure, we are indeed talking about a disappearance of the virus.
The first of them, said to be from Berlin, dates back to 2008. The penultimate, announced a few months before the Montreal conference, concerned a patient treated in New York.
But these patients all have a very specific situation in common. They were suffering from blood cancers and benefited from a stem cell transplant which deeply renewed their immune system.
Recovered patients were lucky: their donor had a rare mutation in a gene called CCR5. It makes the immune system resistant to the main strains of HIV.
In the latest case of cure announced to date, the Californian patient received a bone marrow transplant in 2019. Two years later, he stopped taking his antiretrovirals, as HIV had become undetectable in his body.
This case is all the more interesting because the man, aged 66 and infected for more than 30 years with HIV, is the oldest patient to have been cured. This therefore shows that a cure by stem cell transplant can benefit a relatively old person.
But this observation remains largely theoretical, because it is inconceivable to generalize such a treatment beyond patients with certain cancers.
For most people with HIV, that's not an option, admitted infectious disease specialist Jana Dickter, who treated this patient and who is presenting his case in Montreal, while waiting for this work to be reread from independently and published in a scientific journal.
Stem cell transplantation, most often by bone marrow, is indeed a heavy procedure with significant side effects.
< p class="e-p">The first effect of a bone marrow transplant is to temporarily destroy your own immune system, researcher Steven Deeks, an HIV specialist who does not have participated in this work.
Such a risk is out of the question in someone who does not have cancer, he adds.
Mr. Deeks, who himself presented in Montreal important advances in the way of identifying a cell infected with HIV, nevertheless judges that the Californian patient, like his predecessors, gives interesting leads for finding a treatment one day. which would allow a complete cure.
Such a treatment, he suggests, could be based on CRISPR technology, a method of genetic manipulation which constitutes one of the great scientific advances of recent years.
The idea would be to directly modify the CCR5 genes of infected patients to make their organism resistant to HIV.
Theoretically, it's possible, he concludes. But, for now, that's science fiction.