antibody therapy frees several patients from daily antiretrovirals

If suffering from AIDS ceased to mean a death sentence years ago, it is thanks to antiretrovirals, drugs that manage to keep HIV under control and that have been the salvation of millions of infected people. However, in some cases they either have no effect, or have serious side effects, in addition to requiring strict discipline in their administration, often on a daily basis. Now, an American team has achieved an alternative therapy that controls the virus in the blood through a sporadic combination of antibodies, a type of protein used by the immune system to identify and neutralize viruses and bacteria, although in this case they have been created in the laboratory. Progress, who publishes the magazine Naturesupposes freeing patients from the adverse effects and from the slavery of the calendar.

Identified the second person in the world with HIV who seems to have gotten rid of the virus without treatment

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"Our data demonstrate that combination therapy with antibodies (...) can provide long-term virological suppression without antiretroviral therapy in HIV-positive individuals, and our experience offers guidance for future clinical trials involving new-generation antibodies," the authors note.

In addition, the article points out that the difficulties in sustaining medication for life, long-term side effects and the possibility of developing viruses resistant to antiretroviral drugs have prompted intense research aimed at developing new therapies to achieve "a sustained virological remission ” without the need to take antiretrovirals daily.

Fighting the 'dormant reservoir'

These widely used drugs manage to reduce the viral load in patients, but they are ineffective against the so-called 'latent or persistent reservoir': deposits of virus that remain in infected individuals, hidden in cells of the immune system. These dormant viruses do not replicate in the presence of antiretrovirals. However, if the patient discontinues the medication, they quickly return to the charge.

"Complete eradication of the persistent reservoir of HIV in an infected individual is not feasible with currently available approaches and therapies," the authors note. That is why they propose a “more realistic” alternative to cure, which may be through immune-based therapies, aimed at achieving maximum virological suppression without the need for lifelong and predominantly daily antiretroviral treatment, “and without the need to eliminate the persistent reservoir of HIV in infected individuals”.

Specifically, this therapy consists of the administration of two monoclonal antibodies (that is, created in the laboratory), through three intravenous injections over a period of six weeks.

no side effects

The tests on volunteers were carried out between September 2018 and January 2021, although the coronavirus pandemic forced certain procedures to be shortened. In general, the volunteers reported few side effects (a few cases of fever resolved with ibuprofen).

Seven participants who stopped taking antiretrovirals and received a placebo experienced a viral rebound. Five of the other seven participants who received the antibody injections managed to keep the virus at bay, in some cases for more than eight months. The authors admit that the sample is limited and that a "much larger" study is necessary: ​​"However, our results offer clear evidence that combination therapy with antibodies in individuals with HIV is safe and well tolerated (...) and it offers marked virological suppression without any significant or unforeseen immunological and virological abnormalities.”

And they add that, as laboratories produce the next generation of antibodies with greater amplitude and long half-lives (greater than 60 days), "there is reason to believe that infrequent administration (i.e., twice a year) of such antibodies, possibly in conjunction with a long-acting injectable antiretroviral drug, could lead to long-term (years) suppression of HIV without antiretrovirals in infected individuals.”

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