41 years ago another pandemic began to spread in the world: that of the human immunodeficiency virus (HIV). In 1996, the use of drugs to control the infection began: it is estimated that thanks to the development of these treatments and their access, 16.2 million lives have been saved since 2001.
But over the last two decades, cases have begun to be found of patients achieving sustained remission of infection after receiving HIV medication or after having access to a transplant for another disease. There are also two reported cases of people in the world who, without receiving treatment or a transplant, achieved a sustained remission of the infection.
The sustained remission of the infection is being investigated by scientific researchers in different countries to better understand the interaction between the virus and the human body, and to contribute to the development of better treatments. But the fact that there are such cases of patients in sustained remission does not mean that people with HIV have to stop treatment.
FIRST TWO CASES
One of the last two novelties is the case of the Barcelona patient. She is a 59-year-old woman who was diagnosed with HIV infection and agreed to antiretroviral and immunomodulatory treatment, including 8 weeks of cyclosporine. Then the treatment was suspended, and so she has been 15 years without receiving it.
“She has a virus in her body that is viable, but her own immune system has the ability to completely control it without it being able to produce and rebound after many, many years. That is much more possible than imagining that it can be extrapolated to many of the people with HIV, ”Argentine doctor Juan Ambrosioni, who was part of the patient’s study at the Hospital Clínic de Barcelona, said in an institutional video. The result of the study is presented this week at the 24th edition of the International AIDS Conference in Montreal, Canada.
Consulted by Infobae, the scientist and doctor Natalia Laufer, a specialist in Infectious diseases and a researcher at the INBIRS Institute (which depends on the Conicet and the UBA), told Infobae:
“The Barcelona patient is the case of a person who had HIV, received pharmacological treatment and managed to control the infection. That is, she discontinued treatment and the woman continued without the need to receive treatment again. It is a remission of the infection, ”she explained to Infobae. In these cases, patients are called “post-treatment controllers”.
THIRD CASE
Another case of interest was presented at the Montreal conference: he is the oldest patient to date to have achieved remission of HIV infection after receiving a stem cell transplant for leukemia.
While the transplant was designed to treat the patient’s leukemia, now 66, doctors also looked for a donor who was naturally resistant to the virus. It’s a strategy that first worked on the so-called “Berlin patient,” Timothy Ray Brown, in 2007.
FOURTH CASE
The 66-year-old is the fourth case to have remitted after receiving a transplant and is known as the “City of Hope” patient after the American center in Duarte, California, where he was treated.
He had been diagnosed with HIV infection in 1988 and also received antiretroviral therapy. Following the presentation of the case at the conference in Canada, Sharon Lewin, president-elect of the International AIDS Society, said the case provides “constant hope… and inspiration” for people with HIV and the broader scientific community, though little is known. Transplantation is likely to be an option for most cases due to the risks of the procedure.
What do the different cases of patients in sustained remission imply? Isabel Cassetti, doctor, director of Helios Salud and member of the Argentine Society of Infectious Diseases, responded to Infobae: “The treatment for HIV infection significantly improved people’s survival and quality of life. In recent years, different cases of patients in sustained remission by different pathways have been found. One of them has been the fact that people with HIV needed a bone marrow transplant for leukemias or lymphomas, and then there was a remission of the infection. Four cases have already been reported in the world, including the patient from Ciudad de la Esperanza, in the United States. However, a bone marrow transplant cannot be done for all people with HIV as a treatment strategy. For this reason, gene therapies are now being developed based on the knowledge obtained from these cases.”
In addition, Cassetti pointed out, “sustained remissions have also been confirmed after the suspension of antiretroviral treatment, such as the case of the Barcelona patient, which has now been made known. They are specific populations, which are under investigation. It does not mean that patients have to abandon treatment.” Last year, Cassetti and her team presented the case of Patient C, who had been diagnosed with HIV in 1997 and was treated with very advanced disease, from her onset. She received treatment with combined antiretroviral therapies for a few years, which she then discontinued and had undetectable virus in her blood for 12 years without any treatment.
Another situation is the case of people who achieve remission without receiving drugs. Dr. Cassetti highlighted that less than 1% of the population of people with HIV acquire the infection and achieve remission without accessing treatment. So far, the cases of two patients have been reported -one from California, United States, and the other from Argentina, patient Esperanza- who have achieved sustained remission without access to medication.
The case of the patient Esperanza was investigated by Laufer’s team, and it is considered that it could help to better understand what happens in the body’s immune system when it is affected by HIV. She only received antiviral treatment during pregnancy to ensure there was no chance of vertical transmission to her baby, who was born without the virus. That case was published in the specialized journal Annals of Internal Medicine on November 16, 2021.
