Barcelona patient 'first time we see immune system really beat HIV'

It's been a long four decades since Spain's first AIDS patient was diagnosed at Barcelona's Vall d'Hebron Hospital — before AIDS was even known as AIDS and before the advent of life-saving antiretrovirals that have largely succeeded in making HIV a chronic condition.  

But now, thanks to the so-called 'Barcelona patient', a 75-year-old woman who has kept HIV in check for 15 years without the help of these drugs, Hospital Clínic researchers believe they have discovered a functional cure that could possibly revolutionize HIV care around the globe. 

Catalan News spoke with Josep Mallolas, the head of Hospital Clínic's HIV-AIDS unit, to find out more. 

Who is the Barcelona patient?

The Barcelona patient is a woman who, when she was 59, suffered a primary HIV infection more than 15 years ago. She came to the hospital and she started treatment, special treatment in a clinical trial for a year. She received standard antiretroviral therapy plus other drugs (ciclosporin A). After a year, the clinical trial was finished and she and the other 19 patients who received the same in the clinical trial stopped the treatment. The other 19 had a viral load rebound, but she became undetectable for years and years. This is not a late rebound. She's in good health and has had no problems for more than 15 years.

How has she been able to keep HIV at bay?

The natural killer cells [and CD8+ T cells] in the Barcelona patient are really high [unlike in others with HIV]. This is the first time that we saw that the immune system of a patient really beats an HIV infection. 

30 to 40% of the general population has the specific genetic markers [that she has] but she also received some drug [as part of the clinical trial] that really boosted the natural killers. In the Barcelona patient, the [virus] reservoir has been going down for many years and so we can anticipate that perhaps, in the future, she will be able to totally eliminate HIV in her body.

How does the Barcelona patient differ from other unique cases?

In a few cases, [elite controller] patients don't need antiretroviral therapy. In the beginning, when we see one, their serology for HIV is positive, but the viral load is undetectable so they don't receive antiretroviral therapy. The immunological landscape of elite controllers is totally different from the Barcelona patient, and in the long term, the total number of elite controllers is going down because they lose the battle against HIV. 

The Berlin patient, the London patient, the New York patient and others are HIV patients with a very severe hematological malignancy (blood-forming tissue cancers), who receive cytotoxic drugs (chemotherapy). These cytotoxic drugs eliminate all the immune system and they receive a new partially HIV-resistant bone marrow. Not less than 40-50% of patients die because it is a very severe treatment.

Can the Barcelona patient results be replicated? 

The next step we are working on is a clinical trial. We need, first of all, to identify who has these specific genetic markers and with the patients with these specific genetic markers probably we will add new molecules (drugs) that we know now can boost the natural killers. 

Hospital Clínic treats more than 6,000 HIV patients so this can be a proof of concept study with no more than 40 or 50 cases and later in the future we will see. It could be revolutionary news.