AIDS: promising avenues for moving from remission to cure?

A few weeks ago, American scientists announced thata neat woman in new yorkaffected by leukemiahad recovered from AIDS after receiving stem cells of blood from umbilical cord. Before her, three patients in Berlin, London and Düsseldorf had also been presented as cured, after a bone marrow transplant intended to treat their cancer.

That graft from a compatible donor, whose cells were HIV resistantactually replaced the blood cells of the infected patient and made him a new one immune system. Have we finally found a treatment to cure the virus?immunodeficiency human? In no case, because these are heavy operations, impossible to replicate on a large scale.

Since the virus HIV was isolated in 1983 by the team of Françoise Barré-Fitoussi and Luc Montagnier, science has made giant strides. In 1996, the first tritherapies – a combination of three drugs – notably enabled AIDS patients to live with the virus more or less normally.

Triple therapy, a lifelong treatment

But, as the Sidaction weekend starts on Friday March 25, the organizers are upset that the health crisis continues to undermine activities in the fight against AIDS in France and abroad.

And if tritherapies have the merit of existing, they are not insignificant. There is a higher risk of developing other diseases (cardiovascular, cancer…), access problems, sometimes resistance to treatments, recalled mid-March Michaela Muller-Trutwinprofessor at the Institut Pasteur, on the sidelines of a colloquium of the ANRS-MIE (the French agency for research on AIDS and infectious diseases).

These drugs must also be taken for life. ” Today, patients tell us that they would like a treatment so they can stophighlighted Francoise Barré-Sinoussi at AFP. If they’re expecting this, well it has to be done “. Some patients, treated very early by antiretroviralswere able, after discontinuation of treatment, to control infection naturally “.

Better understand the role of cells natural killers

A very small proportion of patients, infected for a long time with HIV, also manage to live without treatment, no doubt thanks to genetic particularities allowing their immune system to control the virus.

” From these few cases, we can better understand what are the mechanisms that a therapeutic strategy must take into account, underlined Ms. Barré-Sinoussi. More and more data show, for example, the important role played by cells “NK” (natural killer)from lymphocytes of the innate immune system capable of killing infected cells. »

New approaches, based on genetical therapy Where immunotherapy, are also now being studied to modify the cells or the receptors of the virus, she explained. But can we envisage a healing total number of HIV-infected patients?

Healing or remission?

” This would mean that there are no more infected cells in the body at all, and that seems unlikely. “, answered Jennifer Gorwood, in post-doctorate at the Karolinska Institute in Stockholm, Sweden. The problem with HIV is that it inserts itself dormant, latentin the cells, “ and that it can be reactivated, for example when the treatments are stopped “, she continued.

It therefore seems more realistic to hope in the long term for “a remission of HIV which would mean that, even while remaining in the body of a patient, it no longer expresses itself.

” Initially, we thought we had to eradicate the virus 100%, we are beginning to understand that it may be enough to introduce barriers to control it, by making the cells resistant or by stimulating the immune system, underlined Michaela Müller-Trutwin. An achievable goal, but one that could take decades.