Fourteen adult HIV patients have been “functionally cured” with intense anti-viral treatment right after they were exposed to the virus -- much like the Mississippi baby whose story broke earlier this month.
On Friday, in the journal PLoS Pathogens, Pasteur Institute researcher Asier Saez-Cirion and colleagues described how the adult patients’ immune systems are keeping HIV at bay, entering a state of long-term viral remission.
All 14 of what the researchers are calling “post-treatment controllers” were infected in the late 1990s or early 2000s. They received the standard anti-retroviral treatment at the time between one and two months after infection.
None of the patients are “elite controllers” that carry genetic mutations, allowing a person to spontaneously control HIV infection. One such mutation, commonly found in Scandinavia, blocks HIV from entering cells.
The 10 men and four women studied had taken antiviral drugs for anywhere between one year and nearly 8 years. At some point, the patients stopped treatment, either on their own or as part of a treatment-interruption study. After anywhere between four to 10 years off treatment, the patients are still managing to keep their viral levels low.
The early administration of drugs is thought to work by attacking HIV before it has a chance to develop “reservoirs” of its genetic code in infected cells. Laying down a reserve in cells of the body not targeted by anti-HIV drugs is what allows the virus to lie safe and dormant for years, only to reemerge with a vengeance.
As seen in these latest cases and the case of the Mississippi baby, early, aggressive antiviral treatment could smoke HIV out of the body before it gets the chance to hide. Deprived of its reserve forces, HIV can then be beaten back by the immune system. It’s still not a complete cure -- some traces of the virus remain -- but it’s pretty close.
It’s unclear how many people can become “long-term controllers” of the virus, like the 14 patients in the present study. The authors estimate that early treatment could result in a “functional cure” for about 15 percent of HIV patients.
However, amid the excitement that’s sure to ensue with this news, the fact remains that both the French cohort and the Mississippi baby together are just 15 individuals -- not exactly a statistically significant population. And in the case of the baby, some experts question whether we can actually be sure that the infant was infected, since the mother-child transmission rate of HIV is actually relatively low.
Baylor College of Medicine pediatric HIV specialist Mark Kline told ABC News that the hoopla in the wake of the Mississippi case may be unfounded.
"I think we've done a real disservice," Kline said. "We might cause some practitioners to erroneously think that now they should be treating every single baby born to a mother with HIV with potentially toxic medication. We're experimenting on babies who, in many cases, are not even infected with HIV."
The early treatment tactic also doesn’t work for people that have been living with the virus for any significant length of time. For them, the search is still on for hope of any cure -- functional or otherwise.
SOURCE: Saez-Cirion et al. “Post-Treatment HIV-1 Controllers with a Long-Term Virological Remission after the Interruption of Early Intitiated Antiretroviral Therapy ANRS VISCONTI Study.”