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French patients nearly free of HIV show benefit of quick treatment

Fourteen HIV patients who got quick treatment with AIDS drugs have been able to stop the treatment without the virus coming back, French researchers reported on Friday.

While it’s clear the patients are not cured, they may be able to continue healthy lives without the drugs, the researchers report in the journal PloS Pathogens. And their cases point to the importance of diagnosing and treating HIV patients as quickly as possible.

Earlier this month, doctors made headlines with the case of a Mississippi toddler who got a larger-than-usual dose of HIV drugs at birth when it turned out her mother had been infected and didn’t know it. Pre-treatment with the drugs can protect babies from infection at birth, and treating the mothers can further reduce the risk they will pass along infection.

The report about the 14 French patients supports the idea that, at least in some patients, quick treatment may prevent the virus from taking hold in the body.

Quick treatment may also stop the virus from mutating, said Asier Sáez-Cirión of Frances Pasteur Institute and colleagues, who wrote the report. The human immunodeficiency virus that causes AIDS is highly mutation prone, and this makes it hard both for the body’s immune system to control it and to make a vaccine against it.

About 34 million people are infected with HIV, the virus that causes AIDS, globally; 25 million have died from it. While there’s no vaccine, cocktails of powerful antiviral drugs can keep the virus suppressed and keep patients healthy. No matter how long patients take the drugs, however, the virus lurks in the body and usually comes back if the drugs are stopped.

Fewer than one percent of HIV patients somehow manage to control the virus on their own and can stop taking the drugs.

Sáez-Cirión and colleagues were trying to find out how they do it. They studied a database of 3,500 patients. About 1,000 of them had begun taking drug cocktails with 6 months of having been infected, and 70 stopped taking the drugs when the virus was brought under tight control. Some wanted a "drug holiday" and some were taking part in a trial of what's called scheduled treatment interruption -- a way to give patients a break from taking the drugs, which can have unpleasant side-effects.

They singled out 14 who got quick treatment in the late 1990s or early 2000s when they showed symptoms of HIV infection – a rash and fever, for instance. All of them responded very well and within three months the virus had been driven to “undetectable” levels. That means it is barely active and not replicating withing the body.

The patients were able to stop taking the drugs, stay healthy, and the virus stayed at low levels. Tests of their blood showed nothing really unusual, but the virus did not seem to be attacking the immune system cells, called CD4 T-cells, that it usually infects.

If a patient is able to stop taking drugs, doctors call it a "functional cure," even though the virus is still in the body and might come back years later.

“Our results show that early and prolonged (drug therapy) may allow some individuals with a rather unfavorable background to achieve long-term infection control and may have important implications in the search for a functional HIV cure,” the researchers wrote.

Only about 5 percent to 15 percent of patients who get quick treatment are able to control the virus this way, the researchers estimated. Everyone else starts getting signs of infection again when they stop taking the drugs. In these 14 patients, the immune system did not appear to be controlling the virus in the same way as the so-called elite controllers, the 1 percent of people who can do it naturally.

It's possible early treatment prevented the virus from hiding out in long-lived immune cells called viral reservoirs, they said.

“However, it remains unclear why only a limited fraction of patients is able to control the infection after therapy interruption,” the researchers wrote.

Doctors once recommended that patients with HIV not start treatment until they “needed” it – when the virus reached certain levels in the blood, or when the immune system showed a certain level of damage. Now that it’s clear that immediate treatment can keep patients healthier and stop them from infecting someone else, U.S. guidelines say all patients diagnosed with HIV should be treated.