A new experimental therapy seems to have paid off: more than a year after stopping treatment, a man infected with the human immunodeficiency virus (HIV) no longer has the slightest trace of the virus in his body. The exploit was announced on July 7, during the AIDS 2020 conference, by Dr. Ricardo Diaz, of the Federal University of São Paulo, responsible for the clinical study. This long-term remission, however, provokes both fascination and skepticism among the medical profession…
In the midst of a coronavirus pandemic, we would almost forget that other viruses – very contagious and potentially fatal without proper care – are still in circulation. According to the latest UN statistics, nearly 38 million people worldwide are living with HIV (including 1.8 million children) and nearly 690,000 died from AIDS-related illnesses in 2019.
Perhaps a third case of permanent remission
The man in question, a 36-year-old Brazilian, nicknamed “São Paulo patient”, received particularly aggressive treatment with antiretrovirals, combined with taking vitamin B3, for almost a year. Today, no virus particles or antibodies are detectable in his blood, suggesting that this patient is potentially cured of the infection. If this is confirmed, the man would be the third case of a patient diagnosed with HIV with long-term remission. It would also be the first time that the infection has been cleared only medically, without a bone marrow or stem cell transplant.
The very first reported case of “healing”, known as the “Berlin patient”, dates from 2008. The case was particularly complex because the patient had both HIV and cancer (an acute myeloid leukemia). He was finally treated with two stem cell transplants, from a donor with a very specific mutation; the latter blocks infection because it prevents HIV from entering target cells.
The second case, reported by The Lancet HIV, concerns a 40 year old man, called “London patient”. Unfortunately, he too had contracted cancer (Hodgkin’s lymphoma) in addition to the AIDS virus. He was therefore treated similarly to the Berlin patient: he received a stem cell transplant with an HIV-resistant gene. After a remission of 30 months, it now seems that this patient is definitely rid of the virus.
But bone marrow transplants are expensive and complicated procedures that can have serious side effects, making them an impractical remedy for millions of people with HIV…
The “patient from São Paulo”, meanwhile, started standard antiretroviral therapy two months after being diagnosed with HIV in October 2012. He was recruited in 2015 by Dr. Diaz and his colleagues for a study clinical, with four other patients. He is then asked to supplement his treatment with two additional antiretrovirals, and vitamin B3 (which can, in theory, encourage infected cells to “wake up” the latent virus).
After 48 weeks of this intensive treatment, the five participants are asked to resume their initial treatment for three years, after which they stopped all medicines, in March 2019. In four of them, the virus returned quickly. The “São Paulo patient” is still in remission…
A potential “remedy”, which has yet to prove itself
HIV is a particularly sneaky virus: it can stay “dormant” in the body, without triggering the slightest immune response, then suddenly reactivate and replicate. Treatments for HIV generally involve a “cocktail” of three drugs, antiretrovirals that prevent its replication and target different stages of the virus’s life cycle. This can quickly mutate and become more resistant, but it becomes more difficult if several drugs are administered at the same time. This treatment helps reduce the amount of virus in the blood (“viral load”); infected people can thus continue an almost normal life. But if they stop taking the treatment, the infection can start again.
The experimental treatment offered to the man from São Paulo and to the other participants consisted of taking a combination of three drugs: maraviroc (a competitive CCR5 receptor antagonist, which prevents HIV from entering target cells), dolutegravir ( antiretroviral) and nicotinamide (or vitamin B3).
More than a year after stopping all treatment, according to the researchers, there is still no detectable virus in his blood and tissue samples. In addition, the level of anti-HIV antibodies has dropped to an extremely low level, suggesting that the body has gotten rid of the infection. However, most patients who clear HIV with antiretrovirals and stop their treatment see it return to high levels within a few weeks. ” Maybe this strategy is not good for everyone, because it only worked in one in five cases here Says Diaz.
The fact that the patient started treatment very early – two months after diagnosis – may have increased their chances of eliminating the virus permanently.
On the same subject : A new path towards an HIV vaccine
Some believe, however, that it is too early to declare that the man is truly “cured” of HIV. Independent experts in the study believe that the case requires further analysis and that more information should be published on the subject for evaluation by the scientific community. According to them, permanent remission cannot yet be guaranteed at this stage. ” Overall, this is a remarkable statement, but extremely frustrating given the lack of details on the patient’s virological status. Are Paulo », commented on Dr. Jonathan Stoye, head of the retrovirus-host interaction laboratory at the Francis Crick Institute, who did not participate in the study. The exact role of nicotinamide also remains to be clarified and confirmed…
Since its emergence in the 1980s, HIV has infected nearly 76 million people worldwide, of whom nearly 33 million have died from AIDS-related illnesses. No vaccine or remedy has yet been developed to date; antiretroviral therapy, which usually combines three drugs for life, remains the only way to live with the disease today. 25 million people currently benefit from it.
Source : Science
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