Issue: April 2013
April 01, 2013
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Early ART led to long-term remission after treatment discontinuation

Issue: April 2013
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A group of 14 patients with HIV experienced long-term infection control upon discontinuing treatment after starting antiretroviral therapy early during primary HIV infection, researchers from France reported.

“Although in most cases, these advantages wane soon after treatment interruption, the existence of individuals in whom the viral load remains undetectable for several years after interruption of prolonged therapy that was initiated very early after infection (post-treatment controllers) was reported in 2010,” the researchers wrote in PLoS Pathogens. “These individuals hold important clues in the search for a functional HIV cure.”

All of the patients were diagnosed with primary HIV infection in the late 1990s or early 2000s. They received the standard ART and had an undetectable viral load within a median of 3 months. The median treatment duration was 36.5 months. All but two patients experienced an increase in CD4+ T-cell counts before treatment interruption. After treatment interruption, viral control continued for a median of 89 months and the CD4+ T-cell counts remained stable.

The researchers compared the post-treatment controllers with spontaneous HIV controllers, patients with uncontrolled viremia and patients receiving ART. Among the post-treatment controllers, there was a higher prevalence of risk alleles HLA-B*07 and HLA-B*57, but little presence of the protective alleles HLA-B*27 and HLA-B*57. The post-treatment controllers also had weak HIV-specific CD8+ T-cell responses.

“Here, we show that in some HIV-infected individuals with symptomatic primary infection and no favorable genetic background, off-therapy viral control for several years may be associated with a very early and prolonged antiretroviral treatment,” the researchers wrote. “These findings argue in favor of early ART initiation and open up new therapeutic perspectives for HIV-infected patients.”

References:
Sáez-Cirion A. PLoS Pathog. 2013;doi:10.1371/journal.ppat.1003211.

Disclosure: The researchers report no relevant disclosures.