8. Long-term HIV Remission and Post-Treatment Control

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A young woman who was infected with HIV at birth and received very early antiretroviral therapy (ART) as a baby has maintained a viral load below the limit of detectability of standard tests for more than 12 years after stopping 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 many experts thought might be cured of HIV -- was found to still carry the virus, and a pair of bone marrow transplant patients in Boston experienced viral rebound several months after an experimental treatment interruption. This leaves Timothy Brown, the Berlin Patient, as the only person who still appears to have been cured of HIV.

At the International AIDS Society Conference in July, Asier Saez-Cirion from the Institut Pasteur in Paris described the case of a young woman who was born to an HIV-positive mother with a high viral load, given preventive zidovudine (AZT) soon after delivery, but nevertheless became HIV infected. She started combination ART 3 months after birth, but around age 6 she was withdrawn from care. When she came back a year later she had undetectable viral load and stayed off treatment. Now off ART for more than 12 years, the woman has undetectable plasma viral load according to ultrasensitive tests and her CD4 count remains high and stable, but researchers can detect replication-competent HIV DNA in her cells.

Saez-Cirion said this is the first known case of very long-term HIV remission in a person infected around the time of birth and treated early -- about 10 years longer than the Mississippi Baby.

Indeed, such post-treatment control appears rare. Saez-Cirion's group has been following a group of French adults known as the VISCONTI cohort who started treatment during acute or early HIV infection, interrupted therapy, and maintain undetectable plasma viral load. But they are not free of HIV DNA in their T-cells and elsewhere.

A study presented at ID Week in October found that only 4 individuals out of nearly 5000 people receiving care at U.S. military health facilities showed immune control of HIV after starting ART, achieving viral suppression, and interrupting treatment.

Unlike "elite controllers" who have a strong immune response to HIV and maintain low viral load without treatment, the French teenager and some patients in the VISCONTI cohort appear to have an unusually weak response to the virus. This may be advantageous, as their resting T-cells do not become activated and they may avoid the persistent inflammation usually seen in people with untreated HIV. This suggests that calming the immune response to HIV -- rather than strengthening it -- may be one approach to achieving a functional cure.

NEXT: 9. HIV and Hepatitis C Treatment Cost and Barriers to Access