In some patients who are HIV-positive, combination antiretroviral therapy (cART) started as soon as possible may preserve immunity and lead to a so-called functional cure, according to 2 recent reports.
French researchers, led by Asier Sez-Cirin, PhD, of the Institut Pasteur in Paris, and Christine Rouzioux, PharmD, PhD, Necker Hospital, in Paris, identified 14 HIV-positive patients who were treated within the first 2 months of infection (post-treatment controllers) whose viremia remained controlled for several years after the interruption of prolonged cART initiated during the primary infection.
Dr Sez-Cirin and colleagues reported the results of their study, Post-Treatment HIV-1 Controllers with a Long-Term Virological Remission after the Interruption of Early Initiated Antiretroviral Therapy ANRS VISCONTI Study, online in PLoS Pathogens.
This is the second report this month about a functional cure with early treatment for HIV infection. At the Conference on Retroviruses and Opportunistic Infections, researchers reported that cART received in the first few hours of life appears to have eliminated HIV infection in a 26-month-old infected child.The study, Functional HIV Cure After Very Early ART of an Infected Infant, suggests that very early cART may prevent the establishment of a latent reservoir and achieve a cure in children.
In the French study, the infection appears to be under control without the use of drugs, which is defined as a functional cure. This is unlike a “sterilizing” cure, which completely eradicates the HIV.
“These patients initiated treatment very early (in median, less than 40 days after infection) and were on cART for a median of 3 years,” Dr Sez-Cirin told ConsultantLive. “This period of time is much longer than what has been explored so far in clinical trials assessing early treatment. However, only a fraction of those discontinuing a long-term treatment initiated in primary infection are able to control the disease. We don’t know yet how or why. Those with lower levels of viral reservoirs at treatment interruption seem to control infection more often.”
The 10 men and 4 women have now been off therapy for between 4 and 9.6 years. The plasma viral loads of HIV RNA are below 40 copies/mL in all but 3 patients and below 5 copies/mL in 5 patients. The virus is conventionally regarded as undetectable if the plasma viral load is below 50 copies/mL.
Natural HIV controllers (those who control infection despite never having received treatment) are proof that the immune system can control HIV. “The post-treatment controllers in our study are proof of concept that it is possible to ‘induce’ this type of control in patients who were not predisposed to do so spontaneously,” said Dr Sez-Cirin.
The French study may lead to new therapeutic perspectives for persons who carry HIV, he said. “Control of infection was associated with treatment initiation in primary infection,” said Dr Sez-Cirin. “We estimate a 10% to 15% probability for those treated that early and for at least 12 months to control infection after treatment interruption.”
There are more general benefits associated with early treatment as well, including reduction in viral reservoirs, preservation of immune responses, and limitation of viral diversity. Dr Sez-Cirin said, “Patients treated in primary infection may benefit the most from new therapies targeting a cure.”
The Atlantic, “HIV Cures: Where We Are, Realistically”