2024-07-30 04:00:12
Viral particle aggregates (green) produced by T lymphocytes from a patient infected with HIV-1, viewed with a scanning electron microscope. C. Inizan and m. Toulouse/P.Bomi/JM. Parno/Pasteur Institute
In the war against HIV, two main fronts are open. To reduce the number of new infections, we must first reduce the burden of the epidemic. “But we should not forget the 39 million people living with HIV [fin 2022]. It is equally important to seek to heal them.”emphasized Yazdan Yazdanpanah, Director of the National Agency for Research on AIDS (ANRS-MIE), at the International AIDS Conference (AIDS) in Munich, Germany, on Thursday, July 25.
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Here, researchers’ creativity knows no bounds. This is evidenced by their various strategies to cure AIDS. With the same goal: to clear the virus from the infected person’s cells. Because even if antiretroviral treatments successfully stop HIV from multiplying and thus halting the progression of HIV and its complications, they cannot eliminate the invaders, which hide in “reservoirs” scattered throughout the body. cells”. A complex reservoir containing multiple types of immune cells: lymphocytes (especially found in lymph nodes), macrophages, “microglia” (nested in the central nervous system), etc.
The virus persists by integrating its genetic material, or “provirus,” into its genome. Undetectable by the immune system and unreachable by anti-HIV drugs. Sleeping but ready to wake up once the patient stops treatment. In fact, within the next six weeks, it was detected again in the blood. “Few storage cells are enough to cause viral rebound”emphasizes Asier Saez-Cirion of the Institut Pasteur in Paris.
Seven people considered ‘cured’
But there are exceptions. Since 2008, researchers have focused on very rare people—seven so far, six men and one woman— All of these are considered to “cure” HIV infection. “Cure” or “long-term remission”? Experts debate this. Regardless, even if these people stop all antiretroviral treatment for many years (up to more than a decade), the virus remains undetectable in their blood or biopsies. Their levels of CD4 lymphocytes, HIV’s preferred target, remained stable, a sign that the virus is not proliferating over time.
All seven suffered from blood cancer and required bone marrow transplants. In the first five, the bone marrow donors carried mutations in a specific gene: the CCR5 gene, which controls the production of a protein (CCR5 receptor) that sits on the surface of human cells and acts as a portal for viruses to enter. When the gene carries the “Delta32” mutation (on two copies), the virus can no longer enter the cell. That’s the explanation for these very rare treatments.
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