A woman from Barcelona becomes the first patient with HIV capable of controlling the virus without drugs for 15 years

A patient from Barcelona has been controlling HIV for fifteen years without any type of medication, an exceptional case of functional cure for AIDS being studied by the Hospital Clínic to open new avenues of researchaimed at trying to replicate the immunological mechanisms of this woman in other infected.

This case, presented at the AIDS Congress in Montreal (Canada), is different from those known with patients from Berlin and London who achieved an absolute cure for AIDS because the virus disappeared after a stem cell transplant to treat the hematological diseases they suffered from.

In the case of already baptized as “patient of Barcelona”, it is a functional cure, since the woman still has the virus, but her immune system can absolutely control its replication fifteen years after stopping AIDS treatment.

More than fifteen years ago, the patient was diagnosed in the stage of acute HIV infection -the earliest- and was included in a clinical trial with antiretroviral treatment for nine months and various interventions with an immunosuppressant, cyclosporine A.

Antiretroviral treatment, the standard for controlling AIDS, is effective in suppressing viral replication within the body and blocks transmission to other people, so the patient achieves such a low blood level of HIV that it becomes undetectable in a conventional test. But HIV persists in reservoirs, so if therapy is stopped, it has the ability to replicate and can attack the patient again.

However, a very small group of people, such as “the Barcelona patient”, are “aftertreatment controllers” and, after stopping the medication, they manage to maintain undetectable viral loads. Other cases of cure are related to bone marrow transplantation -Berlin and London- or to exceptional cases that have defective viruses or genetic factors associated with a strong immune response to HIV from a type of lymphocyte, patients who are known by the name of “elite controllers”.

The head of the HIV unit at Hospital Clínic, Josep Mallolas, stressed that the Barcelona case “is exceptional not only because there are very few people with long-term post-treatment control (fifteen years), but also by the mechanism ofcontrol of HIV, different from that described in ‘elite controller’ patients and other cases documented to date”. In this sense, “the patient from Barcelona” does not have classical genetic factors associated with disease control or defective viruses, since the researchers isolated samples in the laboratory and found that their HIV had the conditions to replicate.

The researchers also confirmed that their T lymphocytes – key agents of the immune system – are susceptible to HIV infection, suggesting that other cell populations in the blood blocked infection and could contribute to disease control. What is new is that the researchers have characterized the two populations of cells that manage to control HIV: the “natural killer” (NK) cells, which are part of the innate immune system and constitute the first line of defense against different pathogens; and CD8+ T lymphocytes, which play a key role in defending cells against viruses and bacteria.

“Compared to other people, the patient have very high levels of these two populations that may be blocking the virus and destroying infected cells”, highlighted the IDIBAPS AIDS Group researcher Núria Climent.

From now on, the objective of the researchers is to decipher in detail the success model of this patient’s immune system, of which no details have been revealed at the express request of the patient, to determine if it is possible to replicate it in other affected , what would be a giant step in the control of the great pandemic of the second half of the 20th century. Researchers from the Hospital Clínic-IDIBAPS, the University of Barcelona, ​​​​CIBERINFEC, the Germans Trias Hospital in Badalona and the Carlos III Health Institute have participated in the follow-up of the case and the study of the mechanisms.

25% of those infected in Spain are not diagnosed

The AIDS Study Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) has published this Wednesday a study in which it is revealed that 25% of people with HIV in Spain are not diagnosed or they do not have a correct follow-up of their serological situation. All this contributes to the existence of an important breeding ground for opportunistic infections to appear.

Opportunistic infections (OIs) continue to be an important cause of morbidity and mortality in people with HIV infection, and occur in a context in which infected people have a very weakened immune system, especially due to a delay in diagnosis of the disease. AIDS virus and have not yet started antiretroviral treatment (ART).

In order to update the recommendations for the prevention and treatment of different opportunistic infections in patients with HIV infection, GeSIDA has published a new edition of its document in which it condenses, in a “summary, clear and concise” manner, indications on prophylaxis and treatment of multiple opportunistic diseases (parasitic, fungal, viral, mycobacterial, bacterial and imported parasites or fungi), as well as a vaccination schedule with the particularities of patients with HIV infection.