HIV genome eliminated in an untreated patient for the second time

BioTechniques News
Aisha Al-Janabi

A second incidence of a HIV patient’s body eliminating intact HIV genomes without the aid of treatment has been discovered.  

A research team from the Ragon Institute of Massachusetts General Hospital (MGH), MIT and Harvard (all MA, USA) led by Xu Yu (Physician Investigator at MGH) has identified a second patient  the ‘Esperanza Patient’  who has experienced a ‘sterilizing cure.’ This term used by scientists encompasses the eradication of the HIV reservoir by the immune system without treatment. This study was published in the Annals of Internal Medicine and reports that over 1.19 billion blood cells and 500 million tissue cells were sequenced, and no intact HIV genomes were found.  

During HIV infection, a viral reservoir is created through the virus placing copies of its genome into cell DNA. In this form, the virus can evade the action of anti-HIV drugs and the body’s immune response. Although anti-retroviral therapy (ART) blocks new virus production, it cannot remove the reservoir. Daily treatment is required to suppress the virus.  

‘Elite controllers’ is the term coined for people who possess immune systems that can suppress HIV without the assistance of medication. Although they still have viral reservoirs, the immune cell known as a killer T cell keeps the virus suppressed without treatment.  

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The discovery of the Esperanza Patient comes after the first known case of a sterilizing cure in the ‘San Francisco Patient’ in 2020 where no intact HIV viral sequence was detected in their genome. Billions of cells were sequenced to identify any HIV sequence which could have given rise to a new virus; however, none was detected. Nature reported this first incidence of a sterilizing cure without a stem cell transplant in 2020, which Yu discusses here: 

Yu deduces: “These findings, especially with the identification of a second case, indicate there may be an actionable path to a sterilizing cure for people who are not able to do this on their own.” 

She explains that the findings suggest a specific killer T-cell response that occurs in both patients is behind the sterilizing cure response. Yu also discusses the potential treatment developments based on teaching others’ immune systems to mimic these specific responses to the HIV infection. 

Yu concludes: “We are now looking toward the possibility of inducing this kind of immunity in persons on ART through vaccination, with the goal of educating their immune systems to be able to control the virus without ART.” 

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