On the HIV Cure Front

A group of patients in France who became infected with HIV and then started on antiretroviral therapy (ART) early in the post-infection period have shown no signs of a resurgence of their HIV infection seven years after being taken off therapy.

"These results suggest that ... antiretroviral treatment should be started very early after infection," said Charline Bacchus, lead researcher of the study at the French National Agency for Research on AIDS and Viral Hepatitis (ANRS).

The patients in the ANRS EP47 VISCONTI cohort (known as the Visconti Cohort) have an extremely low reservoir of HIV in their cells similar to that of "HIV controller" patients. HIV controllers are those who are able to control their HIV infection without the use of ART for an extended period of time, and represent about one out of every 300 people who have HIV.

In the study, 12 patients started therapy within 10 weeks of infection, were on therapy for an average of three years, and were able to control HIV after an average of seven years off therapy. At a press conference Asier Saez-Cirión, one of the study investigators, said they were interested in finding out whether HIV controller status could be induced. He estimated that 5-15% of those treated early could eventually control HIV off therapy. But don't stop those HIV meds just yet -- not only would we need to figure out how to identify who would have this type of response to early treatment, but also get those individuals onto treatment immediately following infection. The other question one might ask is, could some of those in the study already have been HIV controllers to begin with? While the genetic alleles commonly associated with HIV controllers was not found in these patients there may be other factors playing a role, which researchers now are trying to uncover.

Another study looked at two men who had been infected with HIV for many years, on suppressive antiretroviral therapy (ART), and who underwent treatment of lymphoma via an allogenic (meaning foreign, or from another donor) stem cell transplantation. Both patients received a milder form of chemotherapy, known as the conditioning regimen, prior to transplant, which allowed them to stay on their ART during and after the transplant. One patient was on Atripla, the other on Isentress/Truvada. HIV was detectable in their cells immediately after the transplant, but the transplanted donor cells replaced the patients' own lymphocytes over time. The amount of HIV DNA in their blood cells decreased and became undetectable, for up to two years now in one patient and three-and-a-half years in the other. CD4s declined in both patients initially, followed by a robust CD4 increase in one patient, and the stabilization and no further decline of CD4s in the other.

Unlike Timothy Ray Brown, the "Berlin Patient," who received cells that were resistant to HIV because they lacked the CCR5 receptor, these patients received cells that were CCR5+. It is believed that the antiretroviral treatment protected the donor cells from becoming infected, leading one researcher to refer to it as "a form of PrEP [pre-exposure prophylaxis] at the cellular level." Further tissue sampling and analytic treatment interruption will need to be conducted to assess the full extent of the reduction of HIV in the reservoir.

At a press conference held the same day these two studies were presented, David Margolis, M.D., University of North Carolina at Chapel Hill, was asked by a reporter about the media's role in reporting on cure advances responsibly and accurately, while at the same time not giving too much hope or creating complacency.

"That's your job," said Margolis. "We are very careful about what we say [as researchers], and we've defined cure several different ways. Different kinds of cure and eradication mean different things to different people, and have different levels of value. Perhaps we should come up with a word, like 'complicated-eradication-chemo-immunotherapy,' to slow people down. But you can't argue with the goal and you can't get there without working on it -- and I can't say how long it will take."