March 18, 2013
Fourteen adults who started antiretroviral therapy (ART) soon after becoming HIV-infected and continued treatment for at least a year have been able to control the virus for one to seven years, even after stopping ART, according to French researchers. Lead author Asier Sáez-Cirión called the success a "functional cure" in which the virus is still present in low levels; most of the patients had undetectable HIV blood levels (below 50 copies per milliliter), but some had up to a few hundred copies per milliliter.
Sáez-Cirión described the study patients as "post-treatment controllers" in contrast to "elite controllers" who comprise the less than one percent of HIV-infected people whose bodies are able to control HIV without antiviral drugs. The study indicates that the post-treatment controllers developed high viral loads shortly after infection, which led to starting drug treatment within several months of infection. Post-treatment controllers also have smaller viral reservoirs and a smaller proportion of long-lived immune cells. Elite controllers are able to keep virus levels down, even at the start of infection.
The study did not provide enough information to identify HIV-infected people who could safely stop ART. Dr. Douglas D. Richman, director of the Center for AIDS Research at the University of California-San Diego, emphasized that it is difficult to identify newly infected patients and start treatment in a timely way. Dr. Max Essex, of the Harvard School of Public Health AIDS Initiative, stated that current tests for viral loads are so sensitive it might be possible to take patients off treatment for a month and restart ART if the viral loads go up sharply.
The full report, "Post-Treatment HIV-1 Controllers With a Long-Term Virological Remission after the Interruption of Early Initiated Antiretroviral Therapy ANRS VISCONTI Study," was published online in the journal PLOS Pathogens (2013; doi:10.1371/journal.ppat.1003211).
New York Times
03.15.13; Andrew Pollack, Donald G. McNeil, Jr.