HIV Patient Cured of Infection without Treatment in Extremely Rare Case

The medical community is still looking for a cure for the human immunodeficiency virus (HIV) that causes AIDS. But scientists got some good news this week when they discovered a second person that seems to have cured themselves naturally of the virus. No treatment required. The case lends hope to the idea that scientists may find a way to cure more people of HIV.

Making History

Dr. Xu Yu, of the Ragon Institute of Massachusetts General Hospital, MIT and Harvard, and her colleagues detail the case in a new study published in the Annals of Internal Medicine.

The patient in question is a 30-year-old woman originally from the city of Esperanza, Argentina. She received no regular treatment for infection but is considered a rare “elite controller” of the virus. She was first diagnosed with HIV eight years ago and now shows no signs of an active infection. This kind of incident has only occurred once before.

Elite controllers have immune systems that can control HIV without antivirals. However, they can’t mount the required immune response to get rid of all replicating HIV cells from their systems. Instead, their immune systems control the virus without affecting the reservoirs where HIV continues to make copies of itself and can spread.

The authors believe she has naturally attained some kind of “sterilizing cure” without help from stem cell transplantation or other treatment.

According to the study, the woman was diagnosed in March 2013. She didn’t start antiviral treatment until 2019 when she became pregnant. She took drugs tenofovir, emtricitabine, and raltegravir for six months during her second and third trimesters. After she delivered a healthy HIV-negative baby, she stopped taking the treatments.

The scientists conducted a study of billions of cells in her blood and tissue samples that showed she had been infected with HIV before, but they didn’t find any intact virus that was capable of replicating itself. All they found were seven defective proviruses, a form of a virus that is integrated into the genetic material of a host cell as part of the replication cycle.

The researchers aren’t sure how the patient was able to rid herself of intact, replication-competent virus, but “we think it’s a combination of different immune mechanisms — cytotoxic T cells are likely involved, innate immune mechanism may also have contributed,” Dr. Yu wrote.

“Expanding the numbers of individuals with possible sterilizing cure status would facilitate our discovery of the immune factors that lead to this sterilizing cure in broader population of HIV infected individuals,” Yu added.

If scientists can find a way to create a stabilizing cure, HIV patients wouldn’t have to undergo painful treatments.

“A sterilizing cure for HIV has previously only been observed in two patients who received a highly toxic bone marrow transplant. Our study shows that such a cure can also be reached during natural infection — in the absence of bone marrow transplants (or any type of treatment at all),”

The two people that received bone marrow transplants were able to clear themselves of HIV but only after a full replacement of their immune systems via cell transplantation. Another man from Brazil appeared to have undetectable viral loads after receiving intensified antiretroviral treatment and a vitamin B3 supplement.

“Examples of such a cure that develops naturally suggest that current efforts to find a cure for HIV infection are not elusive, and that the prospects of getting to an ‘AIDS-free generation’ may ultimately be successful,” Yu wrote.

The only other person to have achieved the same results was a 67-year-old woman named Loreen Willenberg, who lived with HIV for 27 years before waking up to find the virus was no longer replicating in her system.

Yu added that their team nicknamed the 30-year-old woman as the Esperanza Patient, named after the town where she is from, which is also Spanish for “hope”.

“This makes us hopeful that a natural cure of HIV is actually possible.” Yu wrote.