The human immunodeficiency virus (HIV) causes a chronic disease when it infects humans that causes a weakening of the immune system , the main defense mechanism against pathogens such as viruses or bacteria. This disease, AIDS, has a great impact on people’s quality of life and currently only treatments that provide some protection can be taken.
However, it is possible that one or more new hopes could completely change how this disease, which affected almost 38 million people in 2018 , is managed, according to the World Health Organization.
What is HIV?
This virus has the ability to infect our cells and block the immune system from being eliminated from the body. This strategy on the part of the virus means that the defenses are not able to recognize other types of viruses that, in another situation, could cause a small infection, in this context it can even lead to death.
Following HIV infection, some patients experience a flu-like reaction for the first few weeks , which then develops into a chronic infection once the virus has invaded and destroyed many immune system cells throughout the body.
Once that point in the infection has been reached, where the defenses of the immune system are completely depleted , we speak of AIDS . From the first events of HIV infection until it becomes AIDS, years can pass, and current treatments focus on delaying this process as much as possible.
Although the prognosis today is much more hopeful than a few years ago , it is still a very difficult disease to deal with and has a great impact on the quality of life of those who suffer from it.
How is HIV treated?
Among the medications available for HIV, there are drugs called antivirals . These compounds prevent the virus from replicating and spreading , slowing down the elimination of the cells of the immune system.
These treatments are effective in keeping the HIV viral load under control , but it’s the closest thing to having a ticking time bomb inside your body, and you never know when it’s going to go off. Although there have been numerous attempts to find a cure, the characteristics of the virus make it a very complicated task.
When can HIV be cured?
Research with stem cell treatments and bone marrow transplants has opened up a wide range of possibilities as a cure for many diseases of the immune system, such as immunodeficiencies or autoimmune diseases. This turned out to be a cure for AIDS in a woman who received a stem cell transplant .
This woman, in addition to suffering from AIDS, also suffered from leukemia (blood cancer). As a treatment for leukemia , the patient received an umbilical cord stem cell transplant from an anonymous donor. Months later, he was able to stop antiviral treatment for AIDS , as he no longer had a viral load in his blood.
Two other male patients also received a stem cell transplant for another disease, and it also turned out to be a cure for their AIDS. The common element in all three cases was a mutation in the stem cells , which seems to give resistance to HIV infection .
Although many more studies are needed to evaluate the application of this technique as a cure for AIDS, it presents an alternative to a chronic disease. The main disadvantage of this treatment is the difficulty of implementing it on a large scale .
It would be necessary to establish a large bank of stem cell donors to identify those that present the specific mutation that grants resistance to infection and also to have enough variants to find a high compatibility between donor and recipient. Gene- editing techniques could also help introduce this mutation to more donors, but that would also increase production costs, making it even less accessible globally.
mRNA vaccines: a new strategy
On the other hand, the technique of vaccines developed with messenger RNA has been a great advance for many diseases. This innovative design opens up new possibilities for tackling diseases that have been researched for many years, such as AIDS.
There have been numerous failed vaccines developed against HIV, but recent studies using mRNA vaccines show great promise. So much so that phase 1 clinical trials in humans began in 2021 , where the main objective was to verify safety, adequate dosage and possible adverse effects.
It is planned to finish this trial in 2023 and if the results are favorable, we could be facing an affordable cure with a global reach. This option has many more advantages than stem cell transplantation, especially for distribution to populations with fewer resources .
Although it is true that we are still at the gates of two great hopes, many studies remain to be carried out. It is possible that, with time and funding, we could have a cure for AIDS in the next few years.
References:
ClinicalTrials.gov. 24 de marzo 2022. A Phase 1 Study to Evaluate the Safety and Immunogenicity of eOD-GT8 60mer mRNA Vaccine (mRNA-1644) and Core-g28v2 60mer mRNA Vaccine (mRNA-1644v2-Core). ClinicalTrials.gov Identifier: NCT05001373
Gupta et al. 2020. Evidence for HIV-1 cure after CCR5Δ32/Δ32 allogeneic haemopoietic stem-cell transplantation 30 months post analytical treatment interruption: a case report. The Lancet HIV. doi: 10.1016/S2352-3018(20)30069-2
Gupta et al 2019. HIV-1 remission following CCR5Δ32/Δ32 haematopoietic stem-cell transplantation. Nature. Doi: 10.1038/s41586-019-1027-4
