Hope for the Elite HIV Controller and Treatment

Will people with HIV soon be able to do without antiretroviral therapy? According to Inserm, about 6,200 people are diagnosed as HIV positive each year in France. Most of them will require antiretroviral treatment to control the virus and prevent the development of AIDS (which affects about 1,200 people every year in the country). But a small fraction manage to control the virus even without this treatment. The rare cases that intrigue experts raise hopes of understanding this mechanism of the virus’s natural neutralization and thus reproducing it in other patients.

Multiple ways to attack HIV

According to Tae-Wook Chun, director of HIV immunovirology at the US Institute of Allergy and Infectious Diseases, only 10 to 15% of patients treated with antiretrovirals develop a substantial immune response within six months of infection. bypassing their treatment. To elucidate the mechanism by which these patients neutralize HIV, Dr. Chun’s team followed two of these patients for five years, thanks to They show that the virus can be controlled in different ways in an article published in nature therapy 28 October, ,It was very interesting because these two patients were showing very different scenarios, he reveals Science and the future. previously had high levels of CD8 T cells Vs virus, but very few neutralizing antibodies. he didn’t fully control Viho So it continued to evolve, leading to sporadic episodes of virus reappearance. While it was the other way around: he showed a very high level of neutralizing antibodies that managed to effectively control the virus over the years, while his CD8 T lymphocyte level was not particularly high. This is very surprising, as it usually takes years for someone to develop such a powerful neutralizing antibody. , Unfortunately, he became infected four years later with another strain of HIV, a strain his antibodies failed to control.

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elite of elite controllers

Even more rare, there are patients who completely eliminate all traces of the virus. Two patients were already able to completely eliminate HIV from their bodies, but only with the help of stem cells from subjects who had the deletion of the CCR5 gene, a protective mutation against this virus. But in 2020 a team from Massachusetts General Hospital and the American Ragan Institute affiliated with MIT and Harvard universities identified the first patient who would have gotten it without the need for this treatment. In an article published in Nature who studied patients who shrank virus beyond detectable limits without the need for antiviral treatment (called elite controllers), they traced a patient who no longer had of HIV genetic material, a 67-year-old Californian woman diagnosed with HIV in 1992. The same team identified a second of these patients in November 2021, a 30-year-old Argentine diagnosed with HIV in 2013, confirming that the eliminated virus is naturally rare but possible.

Seeking treatment to make all patients the elite controller

Thanks to these discoveries, experts hope to be able to reproduce this immune control in all HIV-positive patients. The key may lie in the response of T cells against HIV. Tae-Wook Chun’s team attempted the same thing in 2017 with an experimental vaccine that was supposed to enhance the response of these cells, but unfortunately it did not show clinical efficacy. Despite this failure, researchers do not despair and remain optimistic about other efforts currently underway, such as the RNA vaccine designed by Moderna currently being tested in phase 1 clinical trials or monoclonal antibodies. He is going. ,We do not yet have a vaccine to prevent the transmission of HIV or to bolster the immune response against the virus, but we are currently testing antibodies that work very well and which are only available once per year. Can suppress HIV with two doses reveal tae-wook chun, I think in a short time we will be able to control the virus without using antiretroviral therapy.,

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