Will one of the keys to a cure for HIV come from the aptly named Esperanza? A young woman from Argentina, tested HIV-positive in 2013, recovered from the virus without treatment, say researchers from the University of Buenos Aires, Harvard and MIT (United States) in a study published Tuesday, November 16 by the review Annals of Internal Medicine (in English). They explain that this anonymous patient no longer carries any trace of HIV in her body. She only received antiretroviral treatment for a few months in 2017, during a pregnancy.
So far, only one case of natural cure has been reported, that of a 67-year-old woman in San Francisco in 2020. The authors of this new study hope that their patient’s immune system will help better understand how to fight the disease. virus responsible for AIDS, which today we know to contain, but not to eradicate. To understand the scope of this discovery, franceinfo interviewed Monsef Benkirane, director of the molecular virology laboratory at the Institute of Human Genetics at the University of Montpellier, who is involved in research into new treatments against HIV.
Franceinfo: Are you convinced by this study? Does it really prove the recovery of this patient?
Monsef Benkirane: The study is extremely serious. All the teams involved are leading teams in this field. They had just published an article in the journal Nature on what we call the “elite controllers”, these patients who control the virus [sans être guéris] spontaneously without any treatment. We know them, we know that they represent about 0.5% of the population.
The researchers wanted to study the amount of HIV virus in the body of these patients. That’s how they noticed this woman in whom, by looking for the presence of the virus in 1.1 billion cells, they could not detect it. In patients who control the infection, the virus is still found. At home, absolutely nothing. They then took 150 million TD4 lymphocytes (the type of white blood cells infected with HIV) from him, tried to get the virus out in vitro, which is usually very easy, and they couldn’t. The analysis they made on this patient is simply impressive.
This woman was not on treatment, but still had a few months of triple therapy in 2017 during her pregnancy. Can’t that explain his healing? How to be sure that it is really spontaneous?
From the moment this woman has received treatment, one cannot say the opposite, science obliges to take it into account. But even in patients on triple therapy for thirty or forty years, if you stop the treatment, you will see a rebound in a few weeks. I really don’t think the triple therapy she received contributed to this healing.
Do we know how this spontaneous healing could be explained?
In the “elite controllers”, these patients who spontaneously manage to control the infection, we know that we see a very strong immune response from CD8 T lymphocytes. [un autre type de globules blancs], which is not seen in other patients. About 50% of them carry a gene that also promotes their immune response.
Under certain conditions, does this eliminate all traces of viruses capable of reproducing? One can imagine it. Maybe as soon as a cell with replication-competent virus starts producing it, even a little bit, it will be killed. What we can also think is that in this patient, the virus reservoir cells have a fairly short lifespan.
I am in any case convinced that if we managed to do a job of this magnitude with all the “elite controllers”, we would find other cases of spontaneous recovery. They would remain rare, but would make it possible to build a cohort of patients that we could follow to understand what happened.
How can studying these very specific cases help HIV research?
We will have to come to understand this healing, but it gives leads and hope. We know that contact with HIV does not lead to protection. We can reinfect ourselves, superinfect ourselves … To find a vaccine against this virus, we must therefore succeed in teaching the immune system to do what it cannot do naturally when it encounters HIV. Understanding how this happened in this patient will inevitably have an impact on the strategies to be followed in designing a vaccine. Without forgetting that advances in research against HIV make it possible to acquire knowledge that will be used against other viruses: without them, we would not have had a vaccine against Sars-CoV-2 as quickly.