Since 1996, when triple therapy was introduced, people suffering from the AIDS virus no longer die, some patients are even cured after transplantation, and others, who were treated too early, are able to control their infection naturally. These are examples that give hope that therapeutic paths can lead from remission to cure.
HIV Virus
A few weeks ago, US scientists announced that a New York woman suffering from leukemia had been cured of AIDS after receiving stem cells from umbilical cord blood. Before her, two patients were also reported to be cured after a bone marrow transplant to treat their cancer.
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This transplant from a compatible donor whose cells were resistant to HIV actually replaced the patient’s infected blood cells and rebuilt their immune system. Could we have finally found a cure for the human immunodeficiency virus? Not yet, because these are major operations that cannot be replicated on a large scale.
Since the HIV virus was isolated in 1983 by the team of Françoise Barré-Fitoussi and Luc Montagnier, science has made giant strides. In 1996, the first triple therapy drugs – a combination of three drugs – made it possible for AIDS patients to live more or less normally with the virus.
Triple therapy must be taken for life
While triple therapy has the merit of being available, it is not without its drawbacks. There is an increased risk of developing other diseases (cardiovascular, cancer, etc.), access problems, and sometimes resistance to treatment may also develop.
These drugs also have to be taken for life. Today, patients tell us that they would like a treatment that they can stop taking. If that’s what they are expecting, then we have to do it. Some patients treated very early with anti-retroviral drugs were able to control the infection “naturally” after treatment was stopped.
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A better understanding of the role of natural killer cells
A very small proportion of patients who have been infected with HIV for a long time can also live without treatment, probably because of genetic characteristics that allow their immune systems to keep the virus under control. From these few cases, we can better understand the mechanisms that a therapeutic strategy should take into account. For example, a growing body of data shows the important role played by natural killers (NK cells), lymphocytes of the innate immune system that are able to kill infected cells.
New approaches, based on gene therapy or immunotherapy, are now also being studied to modify the cells or receptors of the virus. But can we imagine a total cure for HIV patients?
Cure or remission?
That would mean that there are no more infected cells in the body, and that seems unlikely with the treatments we have today. The problem with HIV is that it remains latent in the cells, and can reactivate when you stop treatment.
Therefore, it seems more realistic to wait for “remission” of HIV, which would mean that although it is still present in the patient’s body, it is no longer replicating.
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Initially, researchers wanted to eradicate the virus 100 percent, but now they are beginning to understand that it may be enough to just put barriers in place to control it by making cells resistant or stimulating the immune system. It is a goal that can be achieved, but it may take a while.
References
Harper, J., Huot, N., Micci, L., Tharp, G., King, C., Rascle, P., Shenvi, N., Wang, H., Galardi, C., Upadhyay, A. A., Villinger, F., Lifson, J., Silvestri, G., Easley, K., Jacquelin, B., Bosinger, S., Müller-Trutwin, M., & Paiardini, M. (2021). IL-21 and IFNα therapy rescues terminally differentiated NK cells and limits SIV reservoir in ART-treated macaques. Nature Communications, 12, Article 2866. https://doi.org/10.1038/s41467-021-23189-7
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