A French teenager with HIV, which has managed to maintain an undetectable viral load by 12 years without antiretroviral treatment was a major topic of discussion in 8ª International Conference International AIDS Society (IAS) last month in Vancouver. While no one is calling this the case of healing, it raises some interesting questions about "post-treatment control" and may provide clues about how to achieve a functional cure or long-term HIV remission.
Asier Saez-Cirion the Pasteur Institute in Paris described the case in a press conference during the annual conference and pre-conference Symposium "For the cure."
The young woman, who now has 18 years, was infected with HIV during pregnancy or at the time of labor. This was because her mother, who was presented to the obstetrician for the first time during the final period of pregnancy, had a high viral load at delivery and, unfortunately, although the baby had received preventive doses of zidovudine (AZT) shortly after birth , It could not be prevented from developing HIV infection.
After finishing the six weeks of zidovudine, his viral load increased to a high level, confirming that she actually was infected. She then started treatment with ART for three months old.
When she was almost six years the child was removed from the care and lost follow-up. When she returned a year later, the viral load was undetectable blood, even though she was not on ART (Antiretroviral Therapy). She got out of treatment. To 12 years she had substantial "blip" of viral replication (reaching about 500 copies / ml) but then returned to undetectable viral levels.
It now has been without antiretroviral treatment 12 years and has an undetectable viral load in plasma according to ultra-sensitive tests that can measure up to 4 copies / ml. The T cell count CD4 also remains high and stable. But the researchers can detect DNA Viral into your cells - and single cells can be reactivated to produce the virus in the laboratory - showing that she was not cured.
"This case is exceptional - this is something we want to make it clear," Saez-Cirion warning in the press conference:
“A maioria dos pacientes infectados pelo HIV, crianças ou adultos, mesmo se eles começaram o tratamento muito cedo, se eles param o tratamento, eles vão perder o controle de infecção.”
"This young man is still HIV-infected and it is impossible to predict how his health will change over time," Jean-François Delfraissy, director of the French National Agency of AIDS in France (ANRS), agreed. "Her case, however, provides a strong additional argument in favor of initiation of antiretroviral therapy as soon as possible after birth in all infants born to HIV positive mothers."
What tells us this case?
Last year saw a disappointing news in the search for a cure for HIV. In July 2014, researchers announced the baby "Mississippi" - A child who many experts thought could have been cured of HIV - in fact, still carried the virus. Likewise, a pair of bone marrow transplant patients in Boston who showed no signs of HIV infection in its blood or cells while in ART experienced viral rebound several months after experimental treatment interruption.
This leaves the Timothy Brown, the Berlin patientAs the only person who still seems to have been cured of HIV. Almost a decade ago, Brown received bone marrow transplants to treat leukemia, using stem cells from a donor with a naturally occurring mutation in delta-CCR5 32 receptors protect T cells from HIV infection. Although Brown has stopped with ART during this process, HIV did not return. After more than seven years of testing, the researchers were unable to detect replication of virus in their blood plasma, peripheral blood cells or elsewhere who sought.
Although the French teenager not among the ranks of those who may have been cured of HIV, she join a small group of "post-treatment controllers" who seem able to control the virus after they stop antiretroviral treatment.
Saez-Cirion and his colleagues have been following a growing group of French adults, known as the cohort VISCONTI who began treatment during the acute or early HIV infection, and that after discontinued therapy, and maintain the load virus undetectable in blood plasma. But they are not HIV RNA in their free T-cells and elsewhere, as with Brown.
Inspired by VISCONTI group and the baby of the Mississippi, Saez-Cirion team sought a ANRS database of pediatric patients with perinatal HIV infection and identified 100 who started treatment before six months of age. Of these, 15 stopped with ART as her viral load was very low or undetectable. In most of these, the viral rebound cases occurred within one year after stopping treatment. But a child maintained viral suppression for more than three years, and the teenager's viral load remains undetectable.
Saez-Cirion suggested that this is the first case of very long remission of HIV in an infected person on birth time and treated early - about 10 years the baby of Mississippi. A young French woman and VISCONTI cohort are not part of another rare group known as "elite controllers". These individuals have unusually strong immune responses that naturally keep HIV under control despite never taking antiretrovirals. The French teenager had high viral load during the treatment period as a baby, and she has several markers of immune system characteristic of elite controllers.
"This girl has none of the genetic factors known to be associated with natural infection control," Saez-Cirion said. "Probably it is virological remission for as long as she received a combination of antiretroviral drugs, soon after infection."
The French adolescent and some patients in the VISCONTI cohort appear to have an unusually weak response to HIV, and resting T cells do not become activated and thus begin to produce more viruses again.
This may be desirable as it avoids persistent immune activation and inflammation generally seen in people with untreated HIV infection.
This feature aftertreatment controller suggests that soothe the immune system response to HIV - instead of strengthening - may be an approach to carrying out a functional cure.
Note Editor. Rolling this page just below you will find in the third video, a very simple and quick explanation about how HIV reproduces if utlizando-human cellular mechanism, specifically the T-cells CD4