Study: Some Patients May Be “Cured” after Ending HIV Treatment

Posted on 19 March 2013

PARIS, FRANCE — French researchers last week made a startling claim that could forever alter the way HIV/AIDS is studied and treated. They released a report that suggests that rapid treatment of patients after exposure to HIV infection may “functionally cure” about a 1-in-10 of those who are diagnosed early.

The study authors, lead by Professor Asier Sáez-Cirión of the Institut Pasteur in Paris, identified 14 adults who have controlled their HIV infection after they ceased taking the antiviral drugs prescribed for their treatment. The report suggests that other patients may also be able to achieve this so-called functional cure.

The French findings, which were published this week in the journal PLOS Pathogens, come just two weeks after study authors in the U.S. published data concerning a baby with an HIV-positive mother that was born in Mississippi and had apparently been cured of the HIV virus through an aggressive regime of anti-viral drugs that were administered within an hour of birth.

In the case of the French patients, the researchers say that treatment began within months of their infection, which is still faster than in most adult cases.

The French study authors suggest that as many as 15 percent of diagnosed patients who begin early treatment—and who continue it for at least a year—may be able to control the virus without further treatment, sparing them of a lifetime of administering drugs on a daily basis.

Dr. Sáez-Cirión, the study’s lead author, said that the French patients are experiencing “remission” rather than a cure, because the virus is still present at low levels in their bodies.

But using the data to determine why some people are able to “control” the HIV virus may lead to an actual, functional cure—one that would allow individuals to enjoy healthy lives without drug therapies, even if the infection is not completely eradicated.

Experts say that the chief barrier to an actual cure for AIDS is that even when drugs sharply reduce the levels of the HIV infection in the blood, the virus can still stay hidden in the body’s so-called reservoirs. The French study noted that the viral reservoirs in post-treatment controllers were smaller than those for a typically-infected individual, and that these reservoirs had a smaller proportion of long-lived immune cells.

A fraction of people infected with HIV—less than 1 percent—are known as elite controllers, whose bodies keep the virus in check without the use of antiviral drugs. Some of the French study patients may be in this group, and never needed drugs in the first place, although that will never be known since their treatment began so soon after infection was detected.

But the French study authors say that these “post-treatment controllers,” are different from elite controllers, in that the post-treatment controllers tended to have very high viral loads soon after infection, whereas elite controllers are more likely to keep their virus levels down, even at the start of treatment.

One possible outcome of the French research is that people who are taking antiviral drugs may safely be able to stop that treatment. Other experts caution the report does not provide enough information to accurately predict which patients might be able to stop, and that patients should be warned not stop treatment on their own. They point to previous clinical trials which show that, in general, interruption of treatment leads to negative consequences.

The study also suggests that treatment for most people diagnosed with HIV should start earlier. But that isn’t always possible. Many infected persons live for months or years without knowing their HIV status, and some who are aware don’t or can’t start immediate treatment because of the cost of the medications or concerns about the associated side effects.

In the French research, the patients began treatment soon after becoming infected; many of these patients had already exhibited symptoms that alerted their doctors to the presence of infection.

They were each on therapy from between one year to seven and a half years, and have been off treatment for between four and 10 years.

According to the study authors, most of the patients were involved in research to learn if they could take “drug holidays.” But others did stop the treatment on their own.

Since their treatment ended, most of the patients have had viral blood levels below 50 copies per milliliter (CPM), a number that is considered undetectable. Some of them have reported measurements of up to a few hundred copies.

Despite caution about the long-term implications of the research data, experts not connected with the study say that although the “post-treatment controllers” may not be cured, they possess some physiological advantages that research needs to understand further.

They also note that new testing that measures viral loads in the body is accurate and sensitive enough that it might be possible to take people off treatment for short periods, and put them back on medications if their condition rapidly changes.

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