A woman who became infected with HIV in 1992 may be the first person to be cured of the virus without a risky bone marrow transplant or even medication, researchers said Wednesday.
In an additional 63 people in their study who controlled the infection without medication, HIV was apparently sequestered in the body so that it could not propagate, the scientists also reported. The finding suggested that these people may have achieved a “functional cure”.
The study, published in the journal Nature, outlines a new mechanism by which the body can suppress HIV, now only visible due to advances in genetics. However, the study also offers hope that a small number of infected people who have been taking antiretroviral therapy for many years may suppress the virus and stop taking the medication, which may require a toll on the body.
“It does suggest that treatment can cure people, which goes against all dogma,” said Drs. Steve Deeks, an AIDS expert at the University of California, San Francisco, and an author of the new study.
The woman is Loreen Willenberg, 66, from California, already famous among researchers because her body has suppressed the virus for decades after verified infection. Only two other people – Timothy Brown from Palm Springs, California, and Adam Castillejo from London – have been declared cured of HIV.
Bone marrow transplants are too risky to be an option for most people infected with HIV, but the recoveries raised hopes that a cure was possible. In May, researchers in Brazil reported that a combination of HIV treatments may have led to a different cure, but other experts said more tests were needed to confirm that finding.
“I think that’s a novel, an important discovery,” said Drs. Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity in Melbourne, on the new study. “The real challenge, of course, is how you can intervene to make this relevant to the 37 million people living with HIV.”
Even among viruses, HIV is particularly wild and difficult to eradicate. It inserts itself into the human genome and tricks the cell’s machinery to make copies. HIV is found naturally in genes, the most active targets of the cell’s copiers.
In some people, the immune system over time hunts for cells in which the virus has occupied the genome. However, intensive research by participants in this study showed that viral genes can be detected in certain “blocked and blocked” regions of the genome, where reproduction cannot occur, said Drs. Xu Yu, senior author of the study and a researcher at the Ragon Institute in Boston.
The participants in the study were so-called elite controllers, the 1 percent of people with HIV who can control the virus without antiretroviral drugs.
It is possible that some people taking antiretroviral therapy for years may also come to the same outcome, especially if treatments are given that can stimulate the immune system, the researchers speculate.
“This unique group of individuals provided me with a kind of proof of concept that it is possible with the host’s immune response to achieve what is really, clinically, a whole lot,” said Dr. Deeks.
Elite controllers have been extensively researched for directions on how to control HIV. Willenberg has been enrolled in such studies for more than 15 years. With the exception of one test years ago that indicated a small number of viruses, researchers were never able to identify HIV in their tissues.
In the new study, Drs. Yu and her colleagues found 1.5 billion blood cells from Ms. Willenberg and found no trace of the virus, even with sophisticated new techniques that could determine the location of the virus in the genome.
Millions of cells from the intestine, rectum and intestine also have no signs of the virus.
“She could be added to the list of what I think is a cure, through a very different path,” said Drs. Lewin.
Other researchers were supervisors. “It’s certainly encouraging, but speculative,” said Drs. Una O’Doherty, a virologist at the University of Pennsylvania. “I need to see more before I say, ‘Oh, she’s healed.'”
Mar Dr. O’Doherty, an expert in analyzing large volumes of cells, said she was impressed by the results in general.
Another 11 people in the study, who the researchers described as exceptional controllers, had the virus only in a part of the genome so close and distant that the cells of the cell could not replicate it.
Some people who suppress the virus without medication do not have detectable antibodies or immune cells that respond quickly to HIV But their immune system has a strong memory of the virus, the team found.
Powerful T cells, a component of the immune system, eliminate cells in which the viral genes are located in more accessible parts of the genome. The infected cells that remained kept the virus only at distant regions of the genome where it could not be copied.
“That is actually the only explanation for the findings we have,” said Drs. Bruce Walker, a researcher at the Ragon Institute who has been studying elite controllers for 30 years.
About 10 percent of people who take antiretroviral treatments, especially those who start doing so as soon as they become infected, also successfully suppress the virus, even after stopping taking the medication. . Maybe there is something similar among those people at work, experts suggested.
HIV medicine has focused on rooting all viruses hidden in the genome. The new study offers a more accessible solution: If the virus remains only in parts of the genome where it cannot be reproduced, the patient can still achieve a functional cure.
“The part that’s in the ‘deserts’ gene just doesn’t matter,” said Drs. Walker. “It suggests that when we do these studies, we not only need to look at the quantity of the reservoir, but we really need to look at quality.”
Since the researchers completed the study, they have analyzed examples of 40 elite controllers and have found a few more that may qualify as cures, Drs. Yu: “We believe there are absolutely a lot of them.”
With the help of Dr. Deeks contacts people with HIV who have been taking antiretroviral drugs for 20 years or more and who may have managed to spread the virus to their deserts.
Antiretroviral drugs can have severe side effects, including heart disease and organ damage, especially if taken over many years. A functional drug, if confirmed by further research, would change patients’ lives, Drs. Yu: “They can stop their treatment and can just be healed, to be healthy for the rest of their lives.”
