'Exceptional' functional HIV cure in Barcelona woman off antiretrovirals for 15 years

Researchers from Barcelona's Hospital Clínic-IDIBAPS have reported an "exceptional" case of a functionally cured woman with HIV who has not been on antiretrovirals for 15 years.

These findings, made public at the International AIDS Conference on Wednesday, mean that the patient has managed to suppress viral activity without the help of medication for over a decade.

Viral replication typically resumes once people with HIV stop taking antiretrovirals, but that did not occur with this woman, who has been dubbed 'the Barcelona patient'.

'The Barcelona patient'

Few HIV-positive people, such as the so-called elite controllers, can manage their viral loads without treatment.

There are what are known as sterilizing cures thanks to bone marrow transplants as well as patients who have a diminished viral load because they have a rare defective virus or genetic factors associated with strong immune responses.

None of these apply to 'the Barcelona patient', who was diagnosed with an acute infection, was hospitalized for it, and then entered into a clinical trial where she was treated with antiretrovirals for 9 months and given cyclosporin A, an immunosuppressant.

"The Berlin and London patients are completely cured," Núria Climent, an HIV/AIDS researcher at Hospital Clínic-IDIBAPS said referring to the two people who had received bone marrow transplants to treat cancer. "The Barcelona patient still has viable virus that we've been able to replicate, but her infection is under control."

Two types of lymphocytes

Researchers found that the patient's blood cells were highly resistant to HIV infection in in-vitro cultures, but that her purified CD4+ T lymphocytes were susceptible to it, suggesting that other blood cells block the infection and could contribute to suppressing her viral load.

Josep Mallolas y Núria Climent explican el caso excepcional de curación funcional del SIDA en este vídeo #AIDS2022 pic.twitter.com/2NI4DtV1jp

— IDIBAPS (@idibaps) July 27, 2022

Her doctors discovered that she had high levels of two types of lymphocytes that are strongly linked to virus inhibition, natural killer cells and CD8+ T cells. 

Josep Mallolas, another Hospital Clínic-IDIBAPS researcher, explained that now their goal is to find out why this woman has been able to suppress the virus "in order to replicate this with many other people." 

To do so, their next steps will be to study 'the Barcelona patient's' genetic makeup as well as to determine whether the immunosuppressant treatment she received as part of the clinical trial could have played a role in this outcome.