Reacción a "Reactions to the follow-up of a third patient cured of HIV after stem cell transplantation to treat leukaemia"

Every HIV-infected person should receive antiretroviral treatment for two basic reasons: to avoid immune deterioration and consequently becoming ill and developing AIDS; and to prevent the transmission of HIV to others. 

There are two exceptions to this statement: 

1. Patients who, after a period of antiretroviral treatment, abandon it and their immune system is able to control the virus without further treatment. This would be a 'functional cure' as the virus can be isolated from the patient, but is not able to replicate and attack the infected person. There are very few patients described with this 'functional cure' although, recently, the so-called 'Barcelona patient' has been described in providing the immunological details that allow this lady to control the virus by herself after more than 15 years of abandoning antiretroviral medication. 
2. Patients with a 'sterilising cure' of the virus. These are patients who, due to the development of a severe concomitant disease such as leukaemia, undergo a haematopoietic precursor transplant with cells homozygous for CCR5∆32. These cells with this genetic trait (which is in about 1% of the population) are very unlikely to be infected by HIV. In short, these patients may have traces of the virus, but no viable virus that can cause infection and can be considered truly cured of HIV.  

This study provides us with a new case of this type with the particularity that the authors provide a complete immunological and virological characterisation. These cases, at least at present, are anecdotal and cannot be extrapolated to the majority of people living with HIV, as we do not have a large number of haematopoietic precursors with cells homozygous for CCR5∆32 and this is a procedure not without high morbidity and mortality, so it would be unethical to perform it outside the context of treating very serious diseases such as acute leukaemia. However, the few published cases of 'sterilising cure' such as the one in this study have great conceptual value in that they demonstrate that HIV cure is possible. 

Finally, there would be a third exception, which would be those patients referred to as 'elite controllers' who, without ever having received antiretroviral treatment, are able to control viral replication. However, not all authors agree that these patients do not require antiretroviral treatment.