AIDS: find ways to remission

AIDS virus carrier patients cured after transplantation, patients who received very early treatment, are able to naturally control their infection… Therapeutic possibilities are emerging from a few cases in the hope that one day they will be able to go without treatment.

A few weeks ago, American scientists announced that a woman suffering from leukemia, who was being treated in New York, was cured of AIDS after the introduction of cord blood stem cells.

Prior to her, three patients in Berlin, London and Düsseldorf were also presented as cured after bone marrow transplants intended to treat their cancer.

This transplant, from a matched donor whose cells were resistant to HIV, effectively replaced the infected patient’s blood cells and restored a new immune system for him.

Have we finally found a cure for the human immunodeficiency virus? Not at all, because these are heavy operations that cannot be reproduced on a large scale.

Since the HIV virus was isolated in 1983 by the team of Françoise Barré-Sinoussi and Luc Montagnier, science has taken giant strides forward.

In 1996, the first tritherapy, a combination of three drugs, allowed AIDS patients to live more or less normally with the virus.

But while Sidaction weekend kicks off on Friday after raising nearly €4.5 million in contributions last year, organizers are upset that the health crisis continues to dampen AIDS efforts in France and abroad.

And if tritherapy has the merit of existence, they are not negligible.

There is a higher risk of developing other diseases (cardiovascular, oncological, etc.), problems with access, sometimes resistance to treatment, Michaela Müller-Trutvin, professor at the Pasteur Institute, recalled in mid-March on the sidelines of the colloquium of the ANRS-MIE Institute (French Research Agency for AIDS and Infectious Diseases).

– “Natural Killers” –

These drugs also need to be taken “for life”.

“Today, patients tell us they need a treatment they can refuse,” Francoise Barré-Sinoussi told AFP. “If they are waiting for it, then it must be done.”

Some patients who received antiretroviral drugs very early were able to “naturally control the infection” after stopping treatment.

A very small proportion of patients who are long-term infected with HIV also manage to live without treatment, no doubt due to genetic features that allow their immune system to control the virus.

“From these few cases, we can better understand what mechanisms the therapeutic strategy should take into account,” stressed Ms. Barre-Sinussi.

“More and more data show, for example, the important role played by NK (natural killer cells),” the lymphocytes of the innate immune system, which are able to kill infected cells, she illustrated.

She explained that new approaches based on gene therapy or immunotherapy are also being explored to modify the cells or receptors of the virus.

But can we therefore foresee a complete cure for patients infected with HIV?

“That would mean there are no more infected cells in the body, and that seems unlikely,” said Jennifer Gorwood, a researcher at the Karolinska Institute in Stockholm, Sweden.

The problem with HIV is that it enters cells in an inactive, latent form, “and that it can be reactivated, for example, when we stop treatment,” she continued.

Therefore, it seems more realistic to hope for a “remission” of HIV in the long term, which would mean that, even if it remains in the patient’s body, it no longer manifests itself.

“At first we thought that we should destroy the virus by 100%, we are beginning to understand that it may be enough to introduce barriers” to control it, making cells resistant or stimulating the immune system, Mikaela Müller emphasized. Trutvin.

An achievable goal, but it can take decades to reach it.

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