The healing of a third person with HIV, responsible for AIDS, is very important, but not achievable on a daily basis, warns the director of the National Agency for Research on AIDS, Hepatitis and Emerging Infectious Diseases.
“We must focus on treatments, even if we are looking for ways to cure”, advises Professor Yazdan Yazdanpanah. The director of the National Agency for Research on AIDS, Hepatitis and Emerging Infectious Diseases (ANRS) reacted on franceinfo on Tuesday February 21 to the definitive cure of a third patient with HIV (human immunodeficiency virus), following a bone marrow transplant.
franceinfo: How is this third healing possible?
Yazdan Yazdanpanah: First there was the “patient from Berlin”, then the “patient from London”, the third is “the patient from Düsseldorf”. This is a person who has received antiretroviral treatment, a treatment for life. He developed leukemia, a blood disease, and he was transplanted with stem cells. As with the other two cases, there was a cure. Four years after stopping all treatment, researchers have not found HIV in this patient.
It’s a bone marrow transplant, a cumbersome process. What is hope?
It’s very important, it teaches us a lot about healing, but it’s not something you can do every day, in everyday practice. These are patients with serious illnesses, who are offered a bone marrow transplant: patients’ immune cells are changed with cells from donors who have mutations that protect them against HIV. We can’t do it for everyone. A bone marrow transplant, a stem cell transplant, it’s very heavy, with significant risks. On the other hand, it allows us to understand how we can get closer to healing, to show that it is possible.
How do you go from a heavy protocol to a drug for the general public?
The question is not easy. These patients, who receive a bone marrow transplant with immune cells, become resistant to HIV because they have a mutation in a receptor that allows HIV entry into HIV target cells. One way to reproduce this phenomenon could come from gene therapies: trying to introduce this mutation so that people become resistant. Again, this is not something easy to do. There are other mechanisms for eliminating HIV: either targeting and eliminating cells infected with the virus; either make the cells resistant; or optimize immune responses against the virus.
A vaccine is also still awaited. It took just a few months for Covid-19. Why is it so long with HIV? Can RNA be a game-changer?
First of all, you should know that not all viruses are the same. For HIV, we’ve been looking for years, and it’s much more complicated because it’s a different virus. Unfortunately, a fairly advanced clinical trial has just been stopped because it was not effective. There is another in progress, led by Inserm, of which we are going to have the results which are quite promising. RNA is a lead, but just because it works with Covid-19 doesn’t mean it will work with HIV. What is important to remember is that, without minimizing HIV, we now have treatments that are easy to take. It’s for life, yes, but we have treatments to take once a day, with few side effects. We also have long-term treatments, with patients having injections every two months. Treating yourself prevents transmission, it makes the virus undetectable, even if you are not cured. So, for the moment, we must above all concentrate on treatments, even if we are looking for ways of healing, without forgetting prevention. You have to use the basket of tools available: condoms, PrEP, which is a preventive treatment, and especially screening.