Researchers at an IAS conference on HIV pathogenesis, treatment, and prevention held last week in Vancouver presented the case of an 18-year-old girl in France who was born with HIV but appears to be in remission, despite not having taken medication since the age of 6.
Though there is no cure for HIV, there have been some cases in which the virus remains undetectable in someone’s blood without intervention. Researchers hope that by studying this young woman, they can understand how this is possible and how they can replicate it.
The young woman was born to an HIV-positive mother and given an antiretroviral drug called zidovudine for six weeks beginning soon after birth. The original goal of treatment was to prevent her from becoming infected with HIV, but when her viral load got higher, doctors decided to change course and start her on a combination of four drugs.
She stayed on this regimen for years. At some point between the ages of 5 and 6, however, her family decided to discontinue the drugs, though they have not publicly explained why.
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Doctors saw her again at age 6 and were surprised to find that the girl had an undetectable level of HIV in her blood, despite the lack of medication. Twelve years have gone by and the young woman is still not taking medication and still has an undetectable level of HIV.
There are other patients for whom this has happened, at least in the short term. For example, Rewire has written about an infant known as the “Mississippi Baby,” who was born to an HIV-positive mother and given powerful antiretroviral drugs just 30 hours after birth. The baby remained on these drugs for 18 months, at which time her mother stopped bringing her to the clinic.
The next time the doctors saw her, the baby had no detectable virus in her blood stream despite having been off of the medication for five months. She remained off of her medication and continued to have an undetectable viral load until just before her fourth birthday, when a routine test once again found HIV in her blood.
Asier Sáez-Cirión, the researcher who presented this new case last week, also worked with a group of adults in France known as the Visconti patients. These 20 individuals were treated for HIV soon after infection but stopped taking their drugs three years later. Most—18 of them—were able to keep the virus at bay on their own; they have an average of ten years in remission.
Some refer to this kind of remission as a “functional cure” because it does not eliminate the virus from the body, but it prevents the virus from causing harm.
A “true cure” would eradicate HIV from a person’s body. This has proven extremely hard to do because of so-called viral reservoirs—cells in which HIV “takes up residence” and can hide for decades. Functional cures are easier to achieve. In fact, in some ways, antiretroviral therapy can be considered a functional cure because it keeps viral loads down and prevents the virus from causing harm. For most people, however, these drugs will stop working as soon as they are discontinued.
Researchers do not yet know why some patients, like this French teenager or the Visconti patients, are able to continue the success of the drug therapy on their own. These patients seem to share immune gene variations that predispose them to severe early HIV infections. Researchers aren’t sure how this helps them later, but one theory suggests that it may cause their infections to be noticed, and therefore treated, sooner than most people.
Early treatment seems to be a key to functional cures, but it’s also a stumbling block to widespread use of these therapies, because most people don’t know they are infected until months after it happens.
“We are learning from this patient, that’s why it’s so exciting. We are learning clearly which kind of response the strategy for the future should use,” Françoise Barré-Sinoussi, who is credited with co-discovering HIV in 1983 and won a Nobel Prize for her research, said in an interview with CNN. She works at the Institut Pasteur with Sáez-Cirión. “This is critical if we want to make progress in the field of remission in the future,” added Barré-Sinoussi.
Many in the field seem to be tempering their excitement after what happened with Mississippi Baby and other cases in which functional cures ultimately stopped working. Moreover, experts are warning parents that most children will not fare well off of their medication.