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Glossary to understand the advances on HIV and AIDS

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the world still there is no universal cure for HIV, but from an arsenal of drugs and treatments for keep the infection under control and thus prevent the disease known as AIDS from developing. This is, so far, the key premise to understand what it means to contract this virus. Luckily, science is advancing and little by little ways are being found so that, one day, this infection can be completely eradicated.

In recent years, for example, several cases have been described of patients who, either naturally or through some type of medical intervention, have managed to get rid of the virus. His story, the experts wield, is a step forward to continue looking for a cure for this infection which, today, continues to affect millions of people around the world.

These are some of the key terms to understand the medical advances on HIV and AIDS, explained by Julia Whiteprincipal investigator of the Virology and Cellular Immunology group of the IrsiCaixa AIDS Research Institute.

they only know each other four cases worldwide of patients who have managed to get rid of all traces of HIV in their body. These are very exceptional cases. So much so, in fact, his story has been released anonymously under names like the patient from Berlin, the one from London, the one from Düsseldorf and the one from New York. “This phenomenon is known as the sterilizing cure for HIV. It is thus defined only in those cases in which it is observed that the virus has completely disappeared from the patient’s cellsthat there is no trace of the viral genome”, explains Blanco.

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All cases of sterilizing cure for HIV described so far have a point in common. They are all HIV-infected patients who, at some point in their lives, suffered from hematological cancer and they had to go through a bone marrow transplant: a procedure focused on ‘destroying’ part of the patient’s damaged cells and replacing them with healthy ones. “This gives clues for further investigation, but in no case does it represent a viable treatment for patients. Let’s not forget that sometimes these types of procedures involve many risks”, comments the scientist.

Several cases of ‘functional cure of HIV’ have also been described. There are no official estimates of how many patients fit this definition, but according to scientific journals, there are at least a hundred known cases worldwide. “In these cases, we see that patients continue to have HIV infected cells but that the virus does not replicate. It is the equivalent to have the infection under control without the need for treatmentWhite explains.

The ‘functional cure’ of HIV has to do, mainly, with the immune system of the patients themselves. Specifically, with the ability of T lymphocytes to control virus replication. These cases are closely studied by the scientific community to try to decipher what genetic ingredients can contribute to the control of the virus. For now, studies point to a handful of genetic mutations related to different mechanisms of the immune system.

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Within the cases of ‘functional cure’ of HIV, the specialists distinguish a very specific profile of patients: the elite controllers. These are people who were infected with the virus, who took antiretroviral treatment in the early stages of the infection and who, years later, stopped taking the drugs. In these cases, tests show that the virus is still dormant in their cells but is not spreading. The case of the patient from Barcelona, ​​studied from the Hospital Clínic, would fit within this profile.

A very important nuance to understand this type of case, explains Blanco, is that the ‘functional cure’ of these patients not always permanent. “There are cases in which the infection flares up again and patients have to go back on antiretrovirals. This is explained because, unlike the ‘sterilizing cure’, in these cases we know that the virus has not been completely eliminated“, explains the virologist.

antiretroviral treatments

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