It concerns a patient whose body seems to have completely cleared the almost unbeatable virus completely with his own hands. As far as we know, it is only the second HIV patient who has succeeded.

That can be read in the magazine Annals of Internal Medicine. The patient – ​​referred to as the Esperanza Patient in the research article for privacy reasons – was told in 2013 that there was an infection with the human immunodeficiency virus 1 (HIV-1). But it is now eight years later and researchers can no longer find the virus anywhere. And that while the patient has not taken HIV inhibitors for years and the researchers have really looked thoroughly for the virus; they analyzed more than 1 billion blood cells and 500 million tissue cells.

Remarkable

It’s a remarkable story. Not in the least, because those who contract the HIV virus never really get rid of it. This is because the virus has the habit of placing copies of the genome in the DNA of cells during infection, thus creating a so-called virus reservoir. Anti-HIV medication and the immune system cannot get a grip on that virus reservoir. And in most patients, new virus particles can be continuously introduced into the body from that reservoir. Fortunately, antiretroviral agents can prevent the reservoir from generating new virus particles, but the drugs cannot remove the reservoir itself. It means that most HIV patients are dependent on medication for a lifetime.

Elite controllers

But there are exceptions, as researchers discovered years ago. There are people who do not need to take medication after an HIV infection. Researchers also refer to these patients as “elite controllers‘. Like other HIV patients, they do have the virus reservoirs that are so characteristic of HIV, but those reservoirs do not produce new virus particles because a certain type of immune cell – the so-called killer T cells – prevents this.

No virus reservoirs to be found

This elite controllers are obviously very interesting for scientists. Because if we know how they suppress the virus – without medication, this may also provide starting points for a new treatment for patients who are still dependent on medication. American researchers are studying this elite controllers so for many years. And it is during this research that they stumbled upon the Esperanza Patient. This patient can also elite controllers counted and therefore did not use medication to keep the HIV virus under control. But when the researchers then searched the Esperanza Patient’s body for intact genomes of the virus, they couldn’t find anything. It indicates that this patient’s immune system not only kept the virus under control, but even completely cleared the virus reservoirs.

San Francisco Patient

The Esperanza Patient is thus in select company; she is only the second patient that scientists cautiously conclude that she seems to have completely cleared the HIV virus with her own hands. The first patient who succeeded in this – without (drastic) treatment or medication – was the so-called San Francisco Patient. Her case was published in the magazine last year Nature presented (see box).

The San Francisco Patient — later identified as an American woman named Loreen Willenberg — was also extensively studied. The researchers analyzed as many as 1.5 billion of her cells. They did not find the genome of the HIV virus in any of them. This led the researchers to conclude that this elite controller had succeeded in clearing the virus reservoirs. “Elite controllers show us that it is not only possible to be functionally cured of HIV — stopping the virus from doing damage — but it is also possible to completely erase the virus,” said study researcher Bruce. Walker last year. It was world news. Not in the least because until that time we only knew two cured HIV patients and both had only been declared cured after they had undergone a very drastic stem cell transplant – because of cancer. “Loreen is number three,” Walker said. “But she was cured under a potentially fatal bone marrow transplant and through a completely different mechanism that we could potentially translate to other patients.”

That there is now a second elite controller has been found that has cleared the virus reservoirs is very promising. The results suggest that the San Francisco and Esperanza patients used the same immune mechanisms. If researchers manage to understand those mechanisms, they may be able to develop treatments that ‘teach’ the immune systems of other HIV patients to respond in the same way to HIV infection.