Medicine can now contain HIV well enough to prevent it from degenerating into AIDS. The dream now is to heal the sick. A pre-conference on the subject was held Thursday at the University of Montreal Hospital Center (CHUM), as part of the International AIDS Conference.
Posted at 12:00 a.m.
“Tritherapy allows patients to have a normal life, but the virus is still present in them,” explains Éric Cohen, of the Montreal Clinical Research Institute. “HIV hides in reservoirs. We need to understand where these reservoirs are, how HIV keeps itself silent, and how to recognize infected cells in these reservoirs. »
Over the past decade, a handful of patients have been cured by receiving donated bone marrow from people who had a genetic mutation that made them invulnerable to HIV. “It shows the concept can work, but it’s not a viable treatment,” says Dr.r Cohen. Mortality risk [chez les personnes recevant] these transplants is 20%. The patients in question had a cancer for which bone marrow donation was the best treatment.
“The objective is a simple and inexpensive intervention,” says Nicolas Chomont, one of the organizers of the pre-conference, who is an HIV specialist at the CHUM.
“It will probably be a combination of approaches to get the HIV out of its reservoir and then destroy it, or pick it up directly from the reservoir. Monoclonal antibodies used for the treatment of COVID-19 are considered, vaccines could play a role too, as well as immunomodulators that improve the performance of the immune system. »
“We also have genetic approaches with CRISPR technology to introduce the protective genetic mutation in these patients,” he adds. CRISPR technology is a new way of doing genetic engineering.
Space out the treatments
Do they expect to see HIV patients cured before they retire? “I don’t want to make predictions,” said the Dr Chomont. But it’s sequential. 15 years ago, we did not know that it was possible to cure HIV. »
In the short term, this work could lead to improvements in treatments.
We went from 20 pills a day in 1996 with triple therapy to one a day today, and now we are talking about injections every three or six months.
The Dr Nicolas Chomont, one of the organizers of the pre-conference
The other avenue of cure is the study of “super-controllers”, those patients infected with HIV, but whose immune system is capable of putting the latter in check without however eliminating it. In a way, the immune system of these super-controllers plays the role of triple therapy, but without the side effects.
“We sometimes see rebounds in these super-controllers, says the Dr Cohen. We still do not understand how it works, there is also a lot of work in this area. »
There are several hundred super-controllers in the world, a phenomenon known for 30 years.
Some Famous Cases
Berlin
Two patients are said to be “from Berlin” in the world of AIDS. The first is a “super-controller” that has kept HIV in check without antiretrovirals for 25 years. The second is the first case of recovery from AIDS. He is an HIV-positive American who, at the age of 41, in 2007, received a bone marrow transplant to treat leukemia. The donor was himself a “super-controller” and was chosen for this reason by a team of Berlin oncologists and virologists.
London
The second patient to be cured of HIV by a bone marrow transplant is a Briton. He was treated in London at age 32 in 2012 for lymphatic cancer.
The patient Esperanza
Earlier this year, researchers from the United States and Argentina described a 30-year-old patient from Buenos Aires who tested positive for HIV in 2013 but only used triple therapy during pregnancy in 2019. Further analysis surge revealed that it had only seven HIV-infected cells out of more than a billion cells analyzed, and that HIV was defective in each of those seven cells. She is therefore considered to be one of the two known cases of curing HIV without treatment.
The South African child
In 2010, South African researchers treated 227 babies born with HIV for 40 weeks with triple therapy. Only one of them is still living without treatment and without having developed AIDS, which means that his immune system contains HIV even though he does not have the genetic mutations seen in “super-controllers”.
Learn more
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- 25%
- Increase in the number of new HIV cases in Canada between 2014 and 2020
Source: Canadian Foundation for AIDS Research (CANFAR)
- 9%
- Decrease in the number of new HIV cases in the United States between 2014 and 2020
Source: Canadian Foundation for AIDS Research (CANFAR)