HIV, AIDS, virus, storia, pubblicità

Come sappiamo, nonostante decenni di ricerca, l’HIV continua a colpire e non esiste ancora una cura valida.  C’è però un uomo che è riuscito a sconfiggerla completamente: il “Paziente di Berlino”.

Il suo nome è Timothy Ray Brown originario degli Stati Uniti e residente in Germania. Nel 1995 gli venne diagnosticata un’infezione da HIV e cominciò immediatamente la terapia antiretrovirale per tenerla sotto controllo. Undici anni dopo scoprì di essere affetto da una leucemia mieloide acuta che, però, non rispondeva alla chemioterapia. Nel 2007 venne sottoposto ad un trapianto di midollo osseo da donatore sano. Brown reagì bene alle cure e non solo guarì completamente dalla leucemia ma, misteriosamente e inaspettatamente, i livelli di HIV nel sangue erano crollati consentendogli di interrompere la terapia antiretrovirale dal 2009. Ancora oggi è  considerato l’unico uomo completamente guarito dall’Aids.

Cerchiamo ora di capire meglio cosa è accaduto. Secondo gli scienziati che hanno studiato il suo caso sono in gioco vari fattori. In primo luogo Brown ha ricevuto le cellule di midollo osseo da un donatore con una rara mutazione nel gene CCR5 che altera uno dei recettori che l’HIV usa per penetrare nei linfociti, rendendoli così resistenti all’infezione. In secondo luogo il sistema immunitario di Brown era stato “distrutto” dalle massicce dosi di chemioterapia e radiazioni che lo preparavano al trapianto. In fine può essersi verificata una complicanza comune nei trapianti di midollo chiamata “malattia del trapianto contro l’ospite” (GVHD)  ossia le  cellule trapiantate possono aver attaccato le cellule di Brown, complicanza comune nei casi di trapianto di midollo, e aver distrutto le cellule infettate da HIV restanti.

Sono stati condotti vari esperimenti su gruppi di scimmie che, però, non hanno portato ai risultati sperati. Si pensava di essere vicini alla soluzione quando  due pazienti sieropositivi di Boston, che erano stati sottoposti ad un trapianto di midollo osseo “normale” (senza la mutazione del donatore di Brown) per curare il loro linfoma, sembravano guariti poiché il virus era scomparso. Purtroppo qualche mese dopo aver interrotto la terapia antiretrovirale il virus era ricomparso (probabilmente era sfuggito ai test poiché nascosto in qualche parte dell’organismo) . Questo dimostra che non è sufficiente un trapianto di midollo (terapia comunque rischiosa e costosa) ma sono necessari sia la risposta immunitaria chiamata GVHD ma soprattutto che vengano trapiantate cellule staminali con la mutazione del gene CCR5.

Possiamo dunque considerare Brown l’unico uomo, fino ad ora, guarito completamente dall’infezione da HIV .Il suo caso,pubblicato anche sul New England Journal of Medicine (febbraio 2009), ha aperto comunque la strada a nuove interessanti direzioni della ricerca e, forse, anche ad una cura definitiva.

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