“A unique case of HIV cure”: after 15 years without medication, a patient from Barcelona opens a door towards a functional cure for the disease

A Spanish woman carrying HIV has been controlling the virus spontaneously at undetectable levels for more than 15 years without taking medication. The news seems simple to state, but the consequences are enormous. Above all, because as Josep Mallolas, head of the HIV-AIDS Unit at the Barcelona Clinic, has pointed out, they have “been able to find out what is the possible mechanism that allows it”. And that brings us decisively closer to a functional cure for AIDS.

What do we know about the case? Although all the details of the case will be presented this week at the 24th International AIDS Conference in Montreal, the Hospital Clínic team has given a press conference to announce what they have defined as a “unique” and “exceptional” case of functional cure of a disease that affects more than 37 million people worldwide.

From what they have explained, the “Barcelona patient” (whose identity is understandably kept anonymous) was diagnosed in 2006. After that, she was selected for a clinical trial that used certain immunomodulatory treatments (such as cilosporin A) to complete the effect of antiretrovirals and strengthen the immune system. It took nine months for the patient to reduce her viral load in her blood to “undetectable.” 15 years and 50 analyzes later, despite not taking any more medication, the load has remained that way.

Why is it relevant? Illnesses are complex relational phenomena and if we study them case by case we find striking things that, in short, attend more to the particular case than to something that we can use against said illness. With the “Barcelona patient”, for a long time, the researchers believed that they were in that situation. She was the only participant of the 20 individuals who received that treatment that she reacted like this.

In fact, when they studied the patient’s CD4+ T lymphocytes (despite being the main targets of the virus), they found no significant difference. After giving it a lot of thought, they discovered that the key was not in the CD4+, but in the NK cells (“Natural Killer” or “natural killers”) and in the CD8+ T lymphocytes.

What implications does it have? The team has not stopped there, of course. It has been able to determine what types of NK and CD8+ cells are behind this highly effective marking of HIV. That is to say: they have been able to identify the mechanism by which the immune system has been able to control the infection and that opens an infection, what the patient does is control the replication of the patient’s HIV without the need for treatment. To say it roughlythe patient has her own natural antiretrovirals, but the infection is still there (the CD4+ cells continue to maintain their ability to replicate the virus intact)

Then? Is it really that important? The truth is yes. Until now, they required aggressive, complex and expensive treatments that made massive treatment unfeasible. If the researchers at the Clinic are correct and we learn to activate this control mechanism, the situation will change drastically. There is still a lot of work to do, but today is a good day to celebrate hope.

Image | Clinic