The case of the 30-year-old woman, who has not been publicly identified, is described in a new report published in the Annals of Internal Medicine. The woman was diagnosed with HIV in 2013, according to the study, and now shows no active signs of infection or intact HIV in large numbers of her cells. This, the researchers say, implies that she may have been able to achieve what's called a "sterilizing cure" of her HIV infection.
Woman Cured of HIV (CDC). If the virus is not treated, it can lead to acquired immunodeficiency syndrome (AIDS). There is no effective cure for HIV, the CDC says, and people with the virus typically live with it in them for the rest of their lives. The 30-year-old woman seems to be an exception.
To reach that conclusion, researchers analyzed blood samples collected from the woman between 2017 and 2020, along with placental tissue when she had a baby in March 2020. The woman didn't undergo any treatment until 2019 during her pregnancy, when she took the antiretroviral drugs tenofovir, emtricitabine, and raltegravir for six months. After she had her baby (who was HIV-negative), the woman stopped taking the medications.
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And yes, notice the quotes around cure. "By 'cure,' we mean that there is no trace of virus in her body that is able to replicate and generate new viruses," lead study author Gabriela Turk, PhD, of the University of Buenos Aires, tells Health. "Instead, we only found seven copies—an extremely low number—of defective viruses; no signs of active infection or intact virus capable of replicating."
The woman is only the second patient who has achieved a "sterilizing cure" from HIV without undergoing a stem cell transplant (which has been shown to "cure" a few people in the past) or other treatment. The first person, 67-year-old Loreen Willenberg, has also been featured in research. Her body has suppressed HIV for decades after she was diagnosed with the virus in 1992, per The New York Times. In these very rare cases, doctors have referred to the patients as "elite controllers," infectious disease expert Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, tells Health.
How is it possible to be ‘cured’ of HIV in this way?
The short answer is that researchers just don't know. What is known is that "it is the patient's immune system that is doing it," Dr. Yu says. "We believe that multiple components of the immune system contribute, such as T cells and innate immune cells," she adds.
"The main hypothesis is that natural immunity played its part," study co-author Natalia Laufer, MD, PhD, of the University of Buenos Aires, tells Health. "The next challenge is to figure out how it was achieved and try to understand the immune mechanisms that were involved. If this task might have been accomplished, there might be a chance to generate a therapy to recapitulate to same effect in every [person] living with HIV."
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How is a ‘sterilizing cure’ different from taking medicine and achieving a level of disease that is undetectable?
While contracting HIV used to mean that a person would eventually develop AIDS and die of the condition within a few years, HIV can now be controlled with medications that can slow or prevent the progression of the virus. With daily, lifelong antiretroviral therapy (ART), the amount of HIV in an infected person's blood might be made so small that the virus isn't detectable on a standard blood test.
The difference between what happened with this patient and what happens to the vast majority of people who take ART is that HIV treatment only suppresses the virus; it doesn't eliminate it, according to Dr. Yu. "In our patient, there is no intact virus detectable any more, despite analyzing massive amounts of cells," she says. So even though the patient took ART for six months, that alone wouldn't have cured her. In fact, for those taking ART, "HIV persists and comes back as soon as they stop the medicine," according to Dr. Yu.
When HIV gets into the body, it immediately starts making more of itself, John Nelson, PhD, HIV expert and researcher at the Rutgers School of Nursing, tells Health. "The medications are kind of like birth control pills for HIV," he explains. "They prevent, in different ways, the replication of the virus. But people on these medications aren't cured until that HIV that's incorporated into the DNA is completely eliminated. We recommend that all persons with HIV go on medication as soon as they can and stay on the medication for the rest of their life until we find the cure."
Not taking medication will allow higher levels of HIV to circulate in the blood, Nelson says. "The more virus in the blood, the more damage it can do to the body," he explains, listing off the risks of heart attack and stroke as just a few concerns. Plus, he points out, taking medications to suppress HIV prevents people from spreading the virus to others.
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What might this news mean for the future of HIV treatment?
For now, it's important for patients who are diagnosed with HIV to undergo the recommended treatment, Dr. Adalja says. "This [case example] is an elite controller, did not really involve any anti-retroviral treatment, and cannot be easily extrapolated to the general HIV population," he says.
Turk agrees. "When most people living with HIV stop their treatment, the viral load—amount of virus in the blood—bounces from undetectable to detectable levels," she explains. "This reflects that the virus is still in the body, hidden, but ready and able to replicate. In other words, the cells in most people contain 'competent' viruses."
But Dr. Yu is optimistic that things may change in the future. "A cure of HIV is possible and can happen spontaneously in rare cases," she says.
"It may be possible in the future to develop immune interventions that lead to a cure of HIV," Dr. Laufer agrees. "If we are able to understand how her immune system reached this effect, then there might be a chance to generate a therapy to recapitulate to same effect in every person living with HIV. Still, we must say that there is still a long way to go. Current treatments, although not curative, are the best tool we have nowadays to control de virus and remain healthy."
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