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Very early ART and treatment interruptions

The Visconti study was not the only study to find rare cases of HIV-positive people who can interrupt ART and then have prolonged very low levels of viral load. A European-Canadian-Australian observational study called Cascade also found rare cases of virological control lasting more than two years post drug interruption. Cascade researchers searched their dataset of 25,629 HIV-positive people and found that there were 259 who were treated within three months of becoming positive and who later interrupted therapy. These people became HIV positive between 1996 and 2009. Overall, only 11 of the 259 people (4%) were able to maintain their viral loads below the 50-copy mark for more than two years after interrupting therapy. There were seven men and four women, around 30 years old. ART was taken for a year before initiating an interruption.

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Several well-designed clinical trials have found that interrupting ART in people who start therapy later in the course of infection has been associated with a significantly increased risk of serious illness and death. However, it is possible that initiating ART very early in the course of HIV infection (primary HIV infection), as in Visconti and other studies, and taking this therapy for at least three years and then interrupting may allow a very small group of people to control HIV.

Unfortunately, no study to date has uncovered the specific factors—genetics or otherwise—that could help doctors identify such potential patients in future cases of primary HIV infection. Additional analyses from large databases are needed to help confirm that such rare patients exist and to extend analyses of their HIV and immune systems so that clinical trials can try to replicate the findings publicized by Visconti, Cascade and other studies.

—Sean R. Hosein

REFERENCES:

  1. Hocqueloux L, Sáez-Cirión A, Rouzioux C, et al.  Immunovirologic control 24 months after interruption of antiretroviral therapy initiated close to HIV seroconversion. JAMA Intern Med. 2013 Mar 25;173(6):475-7.
  2. Porter K, Lodi S, Meyer L, et al. Immunovirologic control 24 months after interruption of antiretroviral therapy initiated close to HIV seroconversion. JAMA Intern Med. 2013 Mar 25;173(6):475-7.
  3. Lodi S, Meyer L, Kelleher AD, et al. Immunovirologic control 24 months after interruption of antiretroviral therapy initiated close to HIV seroconversion. Archives of Internal Medicine. 2012 Sep 10;172(16):1252-5.
  4. Katz MH. For human immunodeficiency virus disease, more treatment seems to be better: comment on “Immunovirologic control 24 months after interruption of antiretroviral therapy initiated close to HIV seroconversion.” Archives of Internal Medicine. 2012 Sep 10;172(16):1256.