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Scientists have discovered a second HIV patient who is free of the virus


A viral reservoir is formed when HIV copies its genome into the DNA of infected cells, resulting in the formation of a virus reservoir. The virus is effectively hidden from anti-HIV drugs as well as the body's immune response while in this state. The vast majority of people have a reservoir of viral particles that is constantly replenished with new viral particles. However, while antiretroviral therapy (ART) can prevent the production of new viruses, it is unable to eliminate the reservoir, which means that daily treatment is required to keep the virus under control.


Known as elite controllers, some people have immune systems that are capable of suppressing HIV without the use of medication. A type of immune cell known as a killer T cell is responsible for suppressing the virus without the need for medication, even though they retain viral reservoirs capable of producing additional HIV virus.


In his research, Xu Yu, MD, a Ragon Institute member who works at Massachusetts General Hospital as well as MIT and Harvard, has been looking into the HIV reservoirs of elite controllers for several years. Among the patients studied by her research team was one who did not have an intact HIV viral sequence in her genome, indicating that her immune system may have eliminated the HIV reservoir, which is known as sterilization. After sequencing billions of cells from this patient, dubbed the San Francisco Patient, Yu's team looked for HIV sequences that could be used to create new viruses, but they came up empty-handed. This ground-breaking discovery, which represents the first known instance of a sterilizing cure that did not involve the use of stem cells, was published in the journal Nature in 2020.


After discovering the Esperanza Patient, Yu's team reported the discovery of a second untreated HIV-infected patient, dubbed the San Francisco Patient. The Esperanza Patient, like the San Francisco Patient, was found to have no intact HIV genomes in over 1.19 billion blood cells and 500 million tissue cells sequenced. Apparently, this report from the Annals of Internal Medicine may be the second instance of a sterilizing cure being reported.


Because of the discovery of a second case, Yu believes that there may be a path forward toward developing a sterilizing cure for people who are unable to sterilize themselves. Yu is also a physician investigator at Massachusetts General Hospital.


It is possible that other people living with HIV have also achieved a sterilizing cure, as suggested by these findings, which may point to a common killer T cell response driving this response in both patients, she continues. Researchers may be able to develop treatments that teach other people's immune systems to mimic these responses in the case of HIV infection if they can better understand the immune mechanisms that underlie this response.


We are currently investigating the possibility of inducing this type of immunity in people receiving antiretroviral therapy (ART) through vaccination, with the goal of educating their immune systems so that they can control the virus in the absence of ART," Yu continues.

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