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Scientists hoping to cure HIV have proven that an immunotherapy drug can be safely used in humans.
The Phase 1 trial is an important but early step for the University of North Carolina team at Chapel Hill, which has won a $ 20 million grant to bring its ideas to fruition.
Over the past two years, immunotherapy, which drives a person's immune system to attack a disease, has become commonplace and is now used to treat many conditions, ranging from cancer to blindness.
However, scientists are cautious about HIV because attempts to cure the virus with the help of bone marrow transplants (another traditional treatment that replaces a donor's immune system) have been fatal except the person.
For the first time, in a study published today by Cell Reports, the North Carolina team has confirmed its hopes: immunotherapy could be given to HIV-positive patients with no realistic risk of death – and many people could be that.
"We think we can reproduce the results of the Berlin patient [the only person ever cured of HIV]but it will take some time, step by step, "said Dr. David Margolis, co-lead author of the new article.
The Phase 1 trial represents an important but early step for the University of North Carolina team at Chapel Hill, which has won a $ 20 million grant to bring its ideas to fruition.
THE ONLY CURE THAT WORKED EVER – AND WHY IT NEEDS MORE WORK
The only person who has been cured of HIV is an American named Timothy Brown, better known as "Berlin Patient" because he was cured in Berlin in 2007.
Brown already had HIV when he was diagnosed with leukemia, a bone marrow disease that can be treated with a bone marrow transplant.
Bone marrow transplants are usually the last resort because there is a significant risk of death by causing a war between the person's initial immune system and the new implanted system.
But Brown did not have many other options. Once he agreed, his doctor suggested trying to select a donor whose genes were known to be resistant to HIV. At the time, it was more an attempt to protect him than to heal him.
Brown not only survived the operation and survived leukemia, but he had no trace of the human immunodeficiency virus.
The news shook the medical community, speculating that this could be the end of HIV / AIDS.
However, attempts to reproduce it have been devastating.
A report published by the New England Journal of Medicine in 2014 described six attempts to treat HIV-positive patients with a stem cell donation, but none lasted more than a year.
CURRENT ATTEMPTS TO FIND A WORK CURE FOR ALL
More than 10 years later, we are still "very far" to reproduce the case of the Berlin patient, according to Dr. Margolis, even if attempts to this end are not rare.
These days, HIV-positive patients are being prescribed antiretroviral therapy (ART) which is now so effective that it can suppress the virus within six months, so much so that it is considered undetectable and non-transmissible . (It is important to note that becoming undetectable requires the person to take the medication consistently and to remain undetectable requires adherence to the diet.)
Antiretroviral therapy and PrEP (pre-exposure prophylaxis, a pill that protects a person against HIV) have changed the game in the fight against HIV / AIDS, drastically reducing the rate of new infections and chronic disease for life.
However, the only thing that no one can understand, is the elusive phenomenon of latent HIV: strands of the virus that hide and are dormant in "reservoirs" of the body, avoiding treatment.
A team from Oregon's University of Health and Science is tackling this problem by trying to find a cure for the Berlin patient's disease. To do this, they test it on a specific group of monkeys from five monkeys left on an island near Mauritius by Dutch spice traders five centuries ago, making them genetically focused to understand how grafts affect them
The team hopes that it will take more than 10 years to reach tangible and enforceable conclusions that can be replicated in humans.
Meanwhile, Dr. Margolis, her main co-author, Catherine Bollard, of the National Children's Health System, and their team take a different tact, examining the treatment of the moment, immunotherapy.
With support from GlaxoSmithKline, which has a budget of $ 4 million a year, their research team is conducting two concurrent studies.
This phase 1 trial is the first to be published. The goal was to prove that the immune system could be trained to attack HIV, without triggering an internal civil war between cells that could kill the patient.
It was a small study, testing the method on six patients. It was to extract the T cells (a lymphocyte crucial for the immune system), to cultivate them in the laboratory so that they multiply and then reinject them so that they can attack the immune system. virus inside.
All patients in this study had been on antiretroviral therapy for six years on average. They did not see any significant benefit, but it was not the goal. The goal was to make sure it did not hurt anyone.
In the end, the plan is to first administer a therapy that would make HIV disappear before releasing T cells.
The method has been known colloquially as the "shock and death" technique, although it is a term with which Dr. Margolis contests ("it makes it very easy, and B. scary").
"This is a promising breakthrough for the field," says the first author, Julia Sung, of the UNC, though she also warns people against an over-interpretation of the results. "The study has not cured HIV and should not be interpreted as such, but we are also very encouraged by the safety data. So we should not discourage them either. This opens the way to the next step.
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