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Early HIV drugs 'functionally cure about one in 10'

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skycee:
Reading this this morning i just wondered what this meant for those of us who live areas where you cant get treatment till ur cd4 is below 350. I for one found out within weeks of infection and it's been 5months now and still not on treatment....

http://www.nytimes.com/2013/03/16/world/europe/french-study-indicates-some-patients-can-control-hiv-after-stopping-treatment.html?_r=0


French researchers have identified 14 adults who have been able to control their H.I.V. infection for years after stopping treatment with antiviral drugs, a finding that suggests that some patients might be able to achieve a so-called functional cure.

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The report comes only two weeks after doctors in the United States announced that a baby born in Mississippi had apparently been cured of infection with the virus that causes AIDS.

In both cases, scientists said, a crucial element appears to be initiating drug treatment shortly after the infection occurs, though that is not always practical. In the case of the French patients, treatment began within several months of infection, faster than is the case for most adults.

The researchers, who reported their findings this week in the journal PLOS Pathogens, estimated that as many as 15 percent of people who start treatment early and continue for at least a year might then be able to control the virus without treatment, relieving them of a lifelong daily drug regimen.

Asier Sáez-Cirión, the lead author of the study, said that the French patients were in a sort of “remission” rather than being cured, because the virus was still present in their bodies, though at low levels.

Still, he said, figuring out why some people seem to be able to control the virus could point the way toward a functional cure by which people might live healthily without drugs even if their infection was not eradicated.

“This is proof of concept that we can induce this status in individuals who were not going to do so naturally or spontaneously,” said Dr. Sáez-Cirión, an assistant professor at the Pasteur Institute in Paris.

Some AIDS experts agreed. “These people are not cured, but they have some advantages that would be good to understand,” said Dr. Myron S. Cohen of the University of North Carolina.

One implication of the French study is that many people now taking antiviral medications might be able to safely stop. But doctors said the study did not provide enough information to predict which patients that might be, and that patients should not stop on their own.

Previous clinical trials have shown that, in general, interruption of treatments leads to worse outcomes.

Dr. Max Essex, chairman of the Harvard School of Public Health AIDS Initiative, said that new tests measuring viral loads in the body are so sensitive that it “might not be a huge risk to take people off treatment for a month” — and quickly put them back on if H.I.V. was to begin multiplying rapidly.

Another implication of the study is that treatment should be started earlier for most people. But that cannot always be done.

“We and others have difficulty identifying and treating such adults so early after infection,” said Dr. Douglas D. Richman, director of the Center for AIDS Research at the University of California, San Diego.

Many people are infected for months or years without knowing it. Even if they know it, some do not want to start treatment immediately because of the cost of the drugs or concerns about side effects. The patients in the French study started treatment soon after infection because many had symptoms that sent them to the doctors early, allowing their infection to be detected.

Dr. Sáez-Cirión said that most of the patients stopped treatment because they were in studies testing whether patients could take drug holidays. But some just stopped on their own, he said.

The patients were on therapy for one year to seven and a half years. They have been off treatment for 4 to nearly 10 years.

Since stopping treatment, most have had viral blood levels below 50 copies per milliliter, which is considered undetectable. But some have had measurements of up to a few hundred copies.

A small number of people infected with H.I.V. — 1 percent or less — are so-called elite controllers, meaning their bodies keep the virus in check without antiviral drugs. It is possible that some of the French patients might never have needed drugs, but that will never be known because they started treatment so soon after infection.

But the French researchers say the patients, whom they termed “post-treatment controllers,” were different from elite controllers.

Post-treatment controllers tended to have very high viral loads soon after infection, while elite controllers are more likely to keep virus levels down, even at the start, the researchers said. The immune systems of the post-treatment controllers also tended to differ in certain ways from those of elite controllers.

The chief barrier to an AIDS cure is that even when drugs sharply reduce the levels of H.I.V. in the blood, the virus can hide out in so-called reservoirs in the body. Dr. Sáez-Cirión said that the viral reservoirs in post-treatment controllers were smaller than those of a typical infected person and had a smaller proportion of long-lived immune cells.




YellowFever:

--- Quote from: skycee on March 16, 2013, 03:10:56 AM ---Reading this this morning i just wondered what this meant for those of us who live areas where you cant get treatment till ur cd4 is below 350. I for one found out within weeks of infection and it's been 5months now and still not on treatment....

--- End quote ---

Sigh, woe is us.

Although, I'm curious to know if there are biomarkers or metrics that would be useful in determining a functional cure. Lower antibody levels? Presence of broadly neutralising antibodies?

Larsen:

--- Quote from: Cosmicdancer on March 15, 2013, 03:22:27 PM ---I'm not sure why they're saying 10% - 15% of the patients may have achieved a functional cure, when the article clearly says that 70 people stopped treatment and 14 have no detectable viral load after years of stopping treatment.  That comes to exactly 20%.  What am I missing?
--- End quote ---

It is an estimate based on a relatively small sample (the smaller the sample, the larger the margin of error), so I am guessing it is a mixture of healthy caution and margin of error.

Dr.Strangelove:
I'm glad they put 'functionally cured' in quotation marks. It seems that as of late, this term is being thrown around quite a lot. That may not be helpful.
As for those patients, to me it seems that thanks to the early-on treatment they have turned into something like an elite controller. That's not exactly any kind of cure, is it? As we know elite controllers/longterm non-progressors might live with the virus very well for many years but the viral load may come back at some point in time.

To avoid confusion between the different termini, I hereby suggest the introduction of the term "temporary functional cure" ;D
That should describe those patients in the study well enough and make the distinction between this and cases like Timothy Brown, who is actually functionally cured as far as we know.


(I'm just imagining an situation where that's being applied. You go on a date, there is some chemistry and you end up in bedroom. Your date asks: "Do you have HIV?" and you reply "You have absolutely nothing to worry about as temporarily I am functionally cured!"  :P)

littleprince:

--- Quote from: Larsen on March 15, 2013, 07:26:49 AM ---Taken at face value, that would suggest that it isn't beyond the realms of possibility that I am functionally cured; but I can't say that I would feel the least bit inclined to stop treatment in order to find out.

--- End quote ---

Larsen, you could stop treatment and monitor your viral load closely. If it shows an increase then go back onto the same medication you were on previously. There was a trial done recently to see how long people would stay undetectable after treatment stops. From memory the average was about a week before there was a detectable viral load and then when returned to treatment immediately it took about 2 weeks to return to being undetectable. All of the people in the trial returned to be undetectable and had no resistance issues.

It might be difficult to have a doctor do this 'trial' on you however. It would required daily VL tests and a rapid turn around on the results. It wouldn't be the cheapest trial to do either. My guess is that soon a standard test process will be developed to determine functionally cured people. It is probably easier to just stay on meds for another few years.   

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