Moving forward in HIV research

 In early March of this year, a team of French researchers, led by Asier Sáez-Cirión, reported to the journal PLOS Pathogens that they had identified fourteen adults who had been “functionally cured” of HIV, meaning that they had stopped taking ARVs but the virus remains in very low levels in the body. Most of the patients had viral loads of less than 50 copies per milliliter (although some had up to a few hundred per milliliter), causing Dr. Sáez-Cirión to call it a “remission.”

            One key detail in these findings is that these fourteen adults had all started ART within ten weeks of being infected with HIV. Furthermore, the patients (the so-called “Visconti cohort”) were all on treatment for an average of three years before stopping, ranging from one to seven and a half years. Finally, they have all been off of ARVs for at least four years, some up to ten years, without showing significantly higher viral loads.

PEPFAR is one international funder of HIV treatment

            This study is exciting for the future of HIV treatment for many reasons. First of all, the possibility of a “functional cure” for HIV translates into potentially enormous amounts of money being saved on ARVs worldwide, therefore lightening the burden of healthcare costs for governments around the world, and international funders of HIV treatment (for example, PEPFAR).  Additionally, a functional cure for HIV would eliminate, or at least alleviate, the issue of adherence for people with HIV; assuming a functional cure is to be found by following the model taken by these patients (the researchers estimated in their publication in PLOS Pathogens that 15% of people could be functionally cured of HIV, assuming they start treatment early enough and adhere to ART for at least one year), people living with HIV would hopefully be more likely to adhere since it is easier to adhere to a program that lasts for a few years than one that lasts for a lifetime. Adherence can also be an issue due to external factors, such as stock-outs of drugs or transportation costs to a clinic to pick up drugs; hopefully, requiring less drugs overall would mean more likelihood of accessing them for the required time.

The Mthatha depot suffered a stockout and human
resource shortage, which MSF helped to alleviate.

            However, like any study, there are limitations to these findings. The New York Times outlines the possibility that these patients were “elite controllers,” people whose bodies can suppress the virus without help from drugs, and that they only seem to have been cured because they started treatment so quickly after being diagnosed. The team of researchers asserts that these patients are instead “post-treatment controllers,” who are different from elite controllers in that they have a high level of the virus immediately after infection and their immune systems respond in a different way to HIV.

            These findings are especially meaningful to the “treatment as prevention” debate; “treatment as prevention” has the potential to become “treatment as cure” as well. One of the arguments against treatment as prevention is the difficulty in persuading people around the globe to test for HIV (for example, Sizwe’s Test illustrates the cultural and social reasons against getting tested in rural South Africa). If the findings from this study prove to be successful in further research, the implications would be increased pressure on campaigns for testing often and regularly, as well as implementing the “test and treat” strategy (where patients are put on treatment immediately after they test positive for HIV).

Some common ARVs (anti-retroviral drugs)

            These findings are sensational in terms of HIV research because they show that a functional cure for HIV is possible in adults (this was published just weeks after a baby born with HIV was found to be functionally cured as well), through a treatment that already exists. Further findings from a group of Thai patients proved to be similar, although these patients are still on ART, giving reason to believe that research in the field of early treatment as a functional cure for HIV will continue.

- Lindsay Caldarone

Sources:

Andrew Pollack and Donald G. McNeil, Jr, The New Times, “French Study Indicates Some Patients Can Control H.I.V. After Stopping Treatment,” March 15 2013.

http://www.nytimes.com/2013/03/16/world/europe/french-study-indicates-some-patients-can-control-hiv-after-stopping-treatment.html

Keith Alcorn, aidsmap.com, “HIV Cure: The Long Road Ahead,” May 31 2013.

http://www.aidsmap.com/HIV-cure-the-long-road-ahead/page/2665339/