Is it possible to talk about a complete cure for HIV infection ? 

Yesterday the world spread the news about a nine-year-old girl who defeated HIV infection “without treatment” – however, with a deeper study of the issue, it becomes clear that therapy was carried out, albeit quite a long time ago, and English speakers accurately call the child’s condition remission, not cure. We tried to figure out whether it is generally possible to talk about a complete recovery after infections with hepatitis or HIV viruses and whether the body is able to cope with them on its own.

The problem with viruses is that they are all very different and, unlike bacteria, do not have a cellular structure. To destroy bacteria, it is enough to destroy their membrane, that is, the outer wall of the cell itself – this is how the very first antibiotic, penicillin, works . There are antibiotics that disrupt protein synthesis inside bacteria and prevent them from multiplying; Be that as it may, bacteria are independent organisms. The virus, in fact, is a carrier of genetic information – DNA or RNA – in a protein coat with several auxiliary molecules like enzymes. The DNA of the virus can be incorporated into the cell of the human or animal organism in place of the “master” – therefore it is so difficult to develop drugs that destroy viruses and do not damage the cells of the body.

It must be understood that the viability of both bacteria and viruses in the body and outside it is not the same – the same hepatitis viruses can be easily destroyed by high temperatures, for example, when sterilizing dental or manicure instruments. And not all means of exposure are equally applicable inside and outside our body: you can treat the skin with an antiseptic, but you cannot enter it into the blood if bacteria multiply uncontrollably in it. Fragile, quickly dying in the air, HIV becomes powerful and dangerous when it enters the bloodstream – and worst of all, it destroys the immune cells that are called upon to fight infections. Still, scientists are not working in vain, and there are already quite effective drugs that have made HIV infection a chronic disease – and the life expectancy of patients receiving therapy is 70-80 years.

These drugs are called highly active antiretroviral therapy, and they work on different components of the infection and are used in combination with each other. For example, one drug can inhibit a viral enzyme that affects proteins in human cells, while another can block receptors on immune cells, preventing the virus from contacting them. While a person is taking medication, the amount of virus in the blood may decrease to a minimum, but after some time after stopping treatment, HIV infection usually reappears. This period can be several months or a couple of years – or it can be much longer. This happens even without treatment: in some people, HIV infection does not progress eight to ten years after infection, and scientists cannot yet name the exact reason for this.

It is important to understand that there is practically no concept of “zero” in virology: if the virus is not detected, perhaps the sensitivity of the equipment simply does not allow it to be found in such low quantities

What counts as a cure is also a controversial question. For example, in the practice of treating infections with hepatitis viruses, they are considered the so-called sustained virological response. If no relapse occurs within twelve weeks after completion of therapy, then the patient is considered cured. If the hepatitis C virus is detected after a significant period of time after that, it is most likely that reinfection has occurred (this is not uncommon when it comes, for example, about people who inject drugs). It is important to understand that there is practically no concept of “zero” in virology: if the virus is not detected, it is possible that the sensitivity of the equipment simply does not allow it to be found in such low quantities. Another thing is that the body is able to cope with single viral particles of even such dangerous infections on its own.

With HIV infection it is even more difficult: in some studies, the number of viral copies is considered low, less than five thousand per milliliter of blood, in others – less than fifty. If we do not see the virus, can we say that it is completely destroyed? After how many years of remission, can the patient be considered healed and follow up? If a person dies during the period of remission for reasons unrelated to HIV, can it be assumed that a relapse would never have happened? These are not only medical, but also philosophical questions – and so far the case of long-term remission in an African girl only suggests that it is necessary to continue to study the issue and try to understand whether this effect can be achieved in other patients.

In principle, it has long been known about mutations that make the body resistant to HIV infection. It is possible that, in addition to forty weeks of antiretroviral therapy, carried out shortly after birth, the child was helped by some unique feature of the body – it is not yet known which one. At the moment, complete remission, without the possibility of detecting viral particles in the blood, was achieved in three children – and one of them still had a relapse. Today we can only trust doctors and scientists and hope for the success of new developments – and for children in complete remission, expect that it will last a lifetime. Statements like “The child’s immune system coped with HIV infection on its own” should be treated with great caution: so far no one has managed to cope with HIV without treatment, and, unfortunately, such high-profile headlines can lead to refusal of therapy when it is needed.

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