Two new cases of people considered cured of HIV are announced

Known as Ascent and Kansas City patients, the cases will be presented in a session dedicated to HIV cure research, which takes place this Wednesday (29).

The information was anticipated by immunologist Christian Gaebler, from Charité Universitätsmedizin Berlin, during the pre-conference HIV Cure Without Borders: Science, Community and the Latin America and Caribbean Perspective.

"The Ascent patient will be number 12, and then the Kansas City patient will be number 13," Gaebler said, calling the results "really fascinating."

The researcher did not reveal clinical details of the Kansas City patient, such as the type of transplant performed, how long ago he stopped antiretroviral therapy or the period of remission achieved.

The two cases reinforce a still extremely small group of people who eliminated or controlled HIV without medication after a stem cell transplant.

Experts emphasize that this procedure does not represent a therapeutic alternative for the population living with HIV.

All patients considered cured or in prolonged remission also developed leukemia or another hematological cancer that required a bone marrow transplant - a complex, high-risk procedure indicated only for potentially fatal diseases.

“What we can do is learn from all these cases,” Gaebler said.

Since the beginning of the epidemic, around 90 million people have lived or are currently living with HIV. The 13 cases related to transplants represent a tiny fraction of this total, but they have been offering important clues for the development of strategies capable of controlling the virus without continuous treatment.

The first case was that of Timothy Ray Brown, known as the "Berlin patient", presented in 2009 after receiving a transplant from a donor with two copies of the CCR5-delta32 mutation, a genetic alteration that prevents the functional expression of the CCR5 co-receptor, one of the main entry points for HIV into defense cells. For years, it was believed that this mutation was essential for a cure.

The most recent cases, however, have expanded this understanding.

Gaebler highlighted the patient from Geneva, who went into remission despite receiving cells from a donor without the CCR5-delta32 mutation, and the second patient from Berlin, whose donor had only one copy of the genetic alteration. These results suggest that other immunological mechanisms may contribute to virus control.

In the second patient from Berlin, researchers identified antibodies capable of neutralizing HIV and activating NK cells, important components of the immune response, to destroy infected cells.

According to Gaebler, this response may have contributed to gradually reducing viral reservoirs - cells where HIV remains hidden and which represent the main obstacle to a definitive cure.

In addition to transplants, researchers are investigating approaches that could be applied to a much larger number of people living with HIV. These include broadly neutralizing antibodies (bNAbs), CAR-T cell therapies, gene editing of CCR5, and new immunotherapy strategies.

According to Gaebler, different clinical trials with bNAbs have shown a similar pattern: between 10% and 20% of participants manage to maintain partial or complete control of the virus after supervised interruption of antiretroviral therapy.

The researcher also presented preliminary results of an experimental therapy using CAR-T cells modified to recognize HIV and edited in the CCR5 gene. Among ten participants, one kept the virus under control for around 90 weeks without treatment, while another five showed viral rebound lower than expected.

The results are still initial and obtained in small studies, but they help guide the development of therapies that could, in the future, allow people living with HIV to keep the virus under control without depending on the continuous use of medications.

The journalist traveled at the invitation of the IAS (International Aids Society)

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