How close are we to a definitive treatment for HIV?

Transplants or very early treatment of the disease are some of the clues that experts are exploring so that people living with HIV are not forced to take medication until the end of their lives.

The results for the moment are very provisional, just a handful of cases, but encouraging.

A few weeks ago a group of US scientists announced that a woman with leukemia in New York managed to get rid of HIV after receiving stem cells from blood taken from an umbilical cord.

Previously, three patients, respectively in Berlin, London and Dusseldorf, were also cured after a bone marrow transplant, that is, it was originally intended to combat their cancer.

This transplant from a matched donor, whose cells were resistant to HIVallowed to replace the blood cells of the infected patient and reconstitute his immune system.

These cases involve, however, operations that are too delicate, impossible to reproduce in a generalized way.

Since the acquired immunodeficiency virus (HIV) was isolated in 1983 by doctors Françoise Barré-Fitoussi and Luc Montagnier, science has advanced by leaps and bounds.

The first tri-therapies (combinations of three drugs) allowed as of 1996 to save innumerable patients and, for the patients, to lead a reasonably safe life.

Therapies with drawbacks

But triple therapies are not anodyne.

Those who take these drugs (cardiovascular, cancer), and compatibility problems sometimes arise.

In many countries, access to these triple therapies is not guaranteed, recalled Michaela Müller-Trutwin, a professor at the Pasteur Institute in Paris, at a recent colloquium.

“Patients are telling us today that they would like a treatment they can interrupt,” Françoise Barré-Sinoussi explained to AFP. “You have to try”, he added.

Some patients who received very early antiretroviral treatment have been able to after stopping their triple therapy, he explained.

A very small part of these patients, infected with HIV for a long time, manage to get rid of triple therapy, thanks to their genetic characteristics, which allow to strengthen the immune system.

“Based on these cases, it is possible to better understand the mechanisms that must be taken into account in a therapeutic strategy”, added Barré-Sinoussi.

“Every time we have more data that show, for example, the important role played by NK cells (natural killers, “natural killers”)” contained in the lymphocytes of the immune system, capable of explained.

Other new possibilities are gene therapy or immunotherapy, to modify cells or virus receptors, he added.

But one must be cautious about the possibility of totally eliminating the infection in patients.

“That would mean there are no longer any infected cells left in the body, which seems unlikely,” responded Jennifer Gorwood, a post-doctoral student at the Karolinska Institute in Stockholm, Sweden.

The problem with HIV is that it installs itself latently in the cells “and for example, when a treatment is interrupted”he explained.

“At first we thought that the virus had to be 100% eradicated, and now we are beginning to understand that it is enough to introduce barriers” to control it, strengthening the cells or stimulating the immune system, highlighted Michaela Müller-Trutwin. A goal that may need decades.