It’s the news that the HIV community has been waiting four long decades for: the hint that maybe, just maybe, HIV can be cured.
Dr. Xu Yu, a principal investigator at the Ragon Institute of Massachusetts General Hospital, MIT and Harvard, as well as an associate professor of medicine at Harvard Medical School, had to check and recheck her results to be sure. In one of her patients, test after test to detect evidence of HIV in the woman’s blood came up empty. In addition to her lab’s results, “We had complementary assays in labs in Australia, D.C. and Argentina, where the patient is from, all trying to see if they find any evidence of active virus at all, and there was absolutely nothing,” says Yu.
All told, the international team analyzed more than 1.5 billion cells from the patient, who’s from Esperanza, Argentina, and none of the labs found intact traces of HIV’s whole genome in her samples. The woman tested positive for HIV after becoming infected from her partner, but soon after, her body’s immune system was somehow able to control the virus and prevent it from spilling more copies of itself into her body and, more importantly, block it from establishing reservoirs of latent virus in places like the lymph nodes—all without being on the powerful anti-HIV drugs that are normally needed to suppress the virus. This is what sets the Esperanza patient apart. Unlike the handful of other patients who have been able to control the virus, she does not show evidence of these reservoirs, while the others do.
“There is no way to ever say we have proof that there is not a single virus in this patient,” says Yu, who reported the latest case in the Annals of Internal Medicine. “The only thing we can say is that after analyzing a large number of cells from the patient, with the technology in our lab we cannot reject the hypothesis that the patient probably reached a sterilizing cure by natural immunity.”
If that’s indeed the case, she would be only the second case of a patient curing themselves of HIV. Yu also described the first patient, from San Francisco, in 2020, and the fact that she has now found another means researchers can start studying these patients to better understand how these people are able to achieve such a remarkable feat.
Yu and her team have analyzed 1.5 billion blood and tissue cells from the woman since 2017, and they did not find any evidence of intact genetic virus material that would indicate a potentially viable virus. They did, however, find fragments of viral genes, which indicated that the patient was indeed infected with HIV at one point. They found similar clues in the San Francisco patient.
“This person’s body did this itself,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a long-time HIV expert on the Esperanza patient. “It just happened. That means we have got to try to measure every possible parameter and everything in that patient to see if we can find some hint that could possibly be generalized to the public.”
The patient continues to work with Yu’s team to provide blood samples for ongoing research studies. She is currently pregnant with her second child, and Yu and the patient’s doctors are discussing whether her remarkable, apparently virus-free condition means she won’t need to take anti-HIV drugs before and during delivery, as guidelines currently recommend for pregnant women who are HIV positive. She had taken these drugs for six months during her first pregnancy to ensure any virus she might have didn’t get passed on to her child during delivery. The Esperanza patient is also planning to provide the team with samples of her breastmilk once her baby is born so the scientists can determine if it contains any virus.