Two weeks ago, I wrote about the excitement of the Mississippi (USA) baby who was functionally “cured” of HIV, but she is not the only one. A study in France found that 14 adults who started ARV treatment soon after infection and then stopped, have never had to go back on treatment. Off treatment, eight of the 14 patients for four years have maintained completely undetectable viral loads compared to the Mississippi baby who has been off treatment for only over a year. The study was presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2013) this month in America and published in the scientific journal, PLoS Pathogens.
These results are in stark contrast to what was widely accepted when ARVs first came on the market in the 1990s; that once treatment starts, it should not be stopped because patients are unable to control the infection. The French patients began treatment within 10 weeks of infection and were on ARVs for one to three years before stopping, compared to previous studies which only looked at 12-18 month treatment. One of the 14 patients has been off ARVs for nine and a half years.
People infected with HIV who have long term management of HIV without the need for any ARV treatment and have undetectable viral loads are referred to as controllers. About 1 in 300 persons with HIV is an HIV controller. This study suggests that there are different types of controllers, spontaneous controllers who do not require any treatment to manage the virus and post treatment controllers who receive treatment for a period of time and then once off it, maintain a viral load that does not cause any symptoms. These post treatment controllers are not cured in the sense of other HIV controllers but they are functionally cured i.e. they have still have HIV but it does not cause any symptoms. The authors of this study suggest that approximately 15 percent of people with HIV, if they start ARV treatment within six months of infection and continue on treatment for a year could be post treatment controllers compared to one percent who are spontaneous controllers.
The researchers suggest that ARV therapy should start as soon as possible within the primary stage of infections i.e. within six to 12 weeks to reduce the viral reservoirs and help maintain the patient’s immune system and prevents disease progression.
Scientists now have to find out if this works in other patients and settings. If this functional cure is to be studied, then HIV testing rates need to be increased so that people are diagnosed with two months of infection.