Woman possibly cured of HIV withoutmedical treatment

A woman who was infected with HIV in 1992may be the first person curedof the virus without a risky bone marrow transplant or even medications, researchers reported Wednesday.

In an additional 63 people in their study who controlled the infection without drugs, HIV apparently was sequestered in the body in such a way that it could not reproduce, the scientists also reported. The finding suggested that these people may have achieved a “functional cure.”

Theresearch, published in the journal Nature, outlines a new mechanism by which the bodymay suppress HIV, visible only now because of advances in genetics. The study also offers hope that some small number of infected people who have taken anti retroviral therapy for many years may similarly be able to suppressthe virus and stop taking the drugs, which can exact a toll on the body.

“It does suggest that treatment itself can cure people, which goes against all the dogma,” said Dr. Steve Deeks, an AIDS expert at the University of California, San Francisco, and an author of the new study.

The woman is Loreen Willenberg, 66, of California, already famous among researchers because her body has suppressed the virus for decades after verified infection. Only two other people — Timothy Brown of Palm Springs, California, and Adam Castillejo of London

— have been declared cured of HIV. Both men underwent grueling bone marrow transplants for cancer that left them with immune systems resistant to the virus.

Bone marrow trans plants are too risky to be an option formostpeople infected with HIV, but therecoveries raised hopes that a curewas possible. In May, researchers in Brazil reported that a combination of HIV treatments may have led to another cure, but other experts said more tests were needed to confirm that finding.

“I think that is a novel, an important discovery,” Dr. Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity inMelbourne, Australia, said of the new study. “The real challenge, of course, is how you can intervene to make this relevant to the 37 million people livingwith HIV.”

Evenamongviruses, HIVis particularly wily and difficult to eradicate. It inserts itself into the humangenome and tricks the cell’s machinery into making copies. HIV naturally prefers to lurk within genes, the most active targets of the cell’s copiers.

In some people, the immune systemover timehuntsdown cells in which the virus has occupied the genome. But intensive scrutiny of the participantsin this study showed that viral genes maybe marooned in certain“blocked and locked” regions of the genome, where reproduction cannot occur, said Dr. Xu Yu, the study’s senior author and a researcher at Harvard University.

The participants in the researchwere so-called elite controllers, the 1% of people with HIV who can keep the virus in check without antiretroviral drugs.

Itis possible thatsomepeople who take antiretroviral therapy for years may also arrive at the same outcome, especially if given treatments that can boost the immune system, the researchers speculated.

“This uniquegroupof individuals provided to me sort of a proof of concept that it is possible with the host immune response to achieve what is really, clinically, a cure,” Deeks said.

Elite controllers have been exhaustively studied for clues to how to control HIV. Willenberg has been enrolled in such studies formore than 25 years. With the exception of one test years ago that yielded a positive result, researchers were never able to identify any virus in her tissues.

In the new study, Yu and her colleagues analyzed 1.5 billion blood cells from Will en berg and found not race of the virus, even using sophisticated newtechniques that can pinpoint the virus’s location within the genome.

Millions of cells from the gut, rectum and intestine also turned up no signs of the virus.

“She could be added to the list of what I think is a cure, through a very different path,” Lewin said.

Other researchers were more circumspect. “It’s certainly encouraging, but speculative,” said Dr. Una O’Doherty, a virologist at the University of Pennsylvania. “I need to see more before I would say, ‘Oh, she’s cured.’ ”