HIV

Science magazine has named lenacapavir as breakthrough of the year. Lenacapavir is an injectable drug that prevents HIV infection for six months with near 100% efficacy. The publication notes its potential to dramatically reduce infections in high-risk populations, but also reminds that global roll-out will depend on affordability, manufacturing agreements and a robust health infrastructure. Approval of the drug is expected by 2025. 

In the context of World AIDS Day, which is celebrated on 1 December, it is essential to reflect on one of the most urgent challenges in the fight against this disease: HIV in the paediatric population. A project led by the Complutense University of Madrid seeks to reduce paediatric mortality by training research leaders in sub-Saharan Africa and applying technology and innovation.

The risk of HIV transmission through breastfeeding is very low, but it is not non-existent in women living with HIV who have undetectable levels in their blood. Now, for the first time, a study published in the Annals of Internal Medicine has been able to test for HIV in the milk of two such women: one elite controller (who maintains low viral loads without antiretrovirals) and another who had been on treatment for years. Although small amounts of viral DNA were found, the virus was not infectious. The results show that such testing is possible and help confirm the very low risk of transmission.

The Science group is simultaneously publishing four papers (two in the journal Science, one in Science Immunology and one in Science Translational Medicine) that include advances in a sequential vaccination strategy for an effective HIV vaccine. The methods employed aim to obtain broad-spectrum neutralising antibodies and one of the proposals is already in clinical trials. 

Pre-exposure prophylaxis (PrEP), which usually consists of taking a daily oral anti-HIV drug, is a highly effective measure to prevent HIV infection. However, it only works well if people strictly follow the protocol, and some people end up not adhering to it. To improve this situation, researchers have tested an implant under the skin of non-human primates that releases the antiretroviral drug islatravir and maintains adequate concentrations for at least 20 months. The results, published in the journal Science Translational Medicine, show complete protection against infection with repeated exposure.

A study published in the journal Cell shares the case of the "New York patient", a woman with leukaemia and HIV who identifies as "mixed race" and has been free of the virus since 2017. She would be the first woman to be cured of the virus after a bone marrow transplant and there are now four such cases, along with patients in Düsseldorf, Berlin and London. The method involves transplanting HIV-resistant stem cells, this time from umbilical cord blood.

A virological and immunological follow-up confirms that a third patient has been cured of HIV nine years after receiving a bone marrow transplant for myeloid leukaemia, and four years after stopping his antiretroviral treatment. This case of the Düsseldorf patient, similar to two previously documented in Berlin and London, is detailed in a Nature Medicine publication by an international consortium coordinated by the IrsiCaixa AIDS Research Institute and the University Medical Center in Utrecht, the Netherlands. The patient was diagnosed with HIV in 2008 and in 2011 with leukaemia, for which he received the transplant in 2013.

US researchers have designed an intranasal vaccination device that is capable of delivering immunising proteins through the mucosal surface. The research, published in Science Translational Medicine, shows that strong antibody responses against viruses such as HIV and SARS-CoV-2 have been achieved in mice and non-human primates.