In search of cure: Remission of HIV infection and control of long-term post-treatment suggests possibility of functional cure

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Mujer en el mar front of la luna llenaA young woman who was infected with HIV at the birth of her daughter and received antiretroviral therapy (HAART) very early as well as a baby has maintained a viral load below the detectability limit of standard tests for more than twelve years after the suspension treatment, shedding more light on "post-treatment control" as a potential functional cure strategy.

In 2014, researchers reported disappointing news in the quest for an HIV cure. THE "Mississippi Baby" - a child who led many experts to think that the girl might have been HIV - was still found to be carrying the virus and a couple of patients undergoing bone marrow transplantation in Boston; there was viral rebound several months after discontinuation of the experimental treatment. That leaves Timóth Brown, The Berlin patient, as the only person who still seems to have been cured of HIV.

During the International AIDS Society Conference in July, Asier Saez-Cirion of the Institut Pasteur de Paris Described the case of a young woman, who was born to an HIV positive mother with a high viral load who was given preventive maintenance with zidovudine (AZT) soon after delivery, but nevertheless became seropositive. She started the 3 ART combination months after birth, but around 6 years later she was withdrawn from ART. When she returned to the clinic one year later she had an undetectable viral load and we kept her untreated. Now switched off from ART for more than twelve years, the woman has undetectable levels of plasma viral load according to standardized tests and her CD4 count remains high and stableCD4 count remains high and stable, but researchers were able to detect the replication of HIV DNA in their cells.

Saez-Cirion said this is the first known case of remission of long-term care of HIV in an infected person around birth and treated early - about ten years longer than the Mississippi baby.

In fact, such post-treatment controls appear very rarely. Saez-Cirion has followed a group of French adults in a study known as the cohort of VISCONTI who started treatment in the acute or early phase of HIV infection, then stopped it, and maintained undetectable plasma viral load therapy. But they are not free of HIV DNA in your T cells and elsewhere in the body.

Um Study presented in ID Week In October it found that only 4 individuals in a group of nearly 5 thousand people receiving US military health care showed immune control of HIV after starting ART, reaching viral suppression and discontinuation of treatment.

Unlike the "elite controllers"Which have a strong immune response to HIV and keep viral load untreated, the French study and some patients in the VISCONTI cohort appear to have an unusually weak response to the virus. This can be advantageous as their T-cell rest is not activated and they can avoid the persistent inflammation normally seen in untreated people with HIV. This suggests that calming the immune response to HIV - rather than reinforcing it - may be an approach to achieving a functional cure.

Posted on Thursday, 30 2015 December 00: 00

Written by Liz Highleyman

Asier Saez-Cirion at 2015 IAS for an HIV Healing Meeting

Translated by Claudio Souza's original Long-term HIV Remission and Post-Treatment Control at AIDSMAP.COM

Reviewed by Mara Macedo in 3 2016 January

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