What French Teen's HIV Remission Really Tells Us

Rare Case of Acquired HIV Control Raises Hopes, Questions

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Photo Credit: National Institute of Allergies and Infectious Diseases (NIAID)

It was widely reported on July 20, 2015 that a French teenager infected with HIV at birth has been able to control the virus for the past 12 years without use of antiretroviral drugs. The case, presented at the 2015 International AIDS Society conference in Vancouver, sparked both public and media interest, leading some to ponder whether the sustained remission might somehow offers glimpses into an eventual AIDS cure.

It is certainly a unique case, one of several in which patients treated during early infection were reported to have durable suppression of the virus after having stopped therapy. These include the VISCONTI cohort of 20 patients in France and the much-publicized Mississippi baby case, both of which made headlines in 2013.

According to Asier Sáez-Cirión of the Institut Pasteur in Paris, the unidentified girl was born to an HIV-positive mother and given antiretroviral therapy (ART) soon after birth, initially as a prophylaxis to prevent infection but then later as full-time therapy when the child was confirmed to have been infected. Drug adherence was reported to be uneven during the first years of therapy, with several sharp spikes in viral activity, and by the fifth year the child was lost to follow up and the treatment stopped.

However, when the parents returned with the child a year later, the researchers were surprised to find that the girl’s viral load was undetectable.

Twelve years later, the now-18-year-old girl still remains undetectable.

Why the Case Is Unique

Unlike the Mississippi baby—who similarly achieved remission after early ART but eventually rebounded after two years—this new case appears to share greater commonalities with the VISCONTI cohort. As opposed to so-called "elite controllers," who have a natural predisposition for viral control, both the French teen and the VISCONTI patients only seem to have acquired HIV control after prolonged exposure to ART.

Some scientists have speculated that early drug intervention may have prevented the establishment of so-called "latent reservoirs"—essentially, tissues and cells of the body where the virus is able to hide, undetected, even in the face of effective ART. If this is the case, it is possible that the persistency of the virus may also have been inhibited and, with it, the risk of viral rebound.

The exact factors for such acquired control, genetic or otherwise, are still largely unknown. What does seem clear, however, is that early ART, while beneficial in all other regards, does not inherently confer to better viral control and that, in all but a few rare cases, the virus will invariably rebound if and when ART is stopped.

Possible Key to an AIDS Cure?

Whether the French teen or the VISCONTI cohort will provide any greater insights into the development of novel therapies also remain unclear.

By and large, efforts to replicate biomedical remission in patients with HIV have failed, including attempts to repeat the "cure" of Timothy Brown, a.k.a. The Berlin Patient, who many believe was cleared of HIV after an receiving an experimental bone marrow transplant.

In 2014, two Boston men given a similar transplant experienced rebound after one year of viral remission.

Similarly, claims that five Canadians babies were "functionally cured" in 2013 after receiving early ART were soon retracted when one of the five babies rebounded after its treatment was stopped. (The other four, whose treatment was never stopped, remain on ART to this day.)

Furthermore, some have begun to question whether the replication of elite control is, in and of itself, the holy grail of AIDS research that many presume it to be. Recent research from John Hopkins has, in fact, suggested that the benefits of elite control may come with serious, long-term consequences, with nearly twice the number of hospital admissions, three times the cardiovascular disease admissions, and four times the psychiatric admissions when compared to non-elite controllers on fully suppressive ART.

This suggests that even with "natural" viral control, persistent, low-level viral activity and hidden reservoirs of latent HIV can still reap havoc by submitting the body to decades of unimpeded chronic inflammation.

So while cases like that of the French teen may, in fact, provide invaluable insights into the mechanisms for HIV control, the most important insight may be that of early intervention itself.  By ensuring the early testing of HIV and the immediate treatment for those infected, the likelihood of illness and death—as well as the transmission of the virus to others—can be dramatically decreased.

And that may ultimately be the holy grail of AIDS research that finally ends this crisis.

The HIV/AIDS Channel of About.com is pleased to have been named one the "Best HIV/STD Health Blogs" of 2015 by the editors of Healthline.

Sources:

Frange, P.; Faye, A.; Avettand-Fenoëll, et al. "HIV-1 virological remission for more than 11 years after interruption of early initiated antiretroviral therapy in a perinatally-infected child." 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention; July 20, 2015; Vancouver, British Columbia; oral abstract MOAA0105LB.

National Institute of Allergy and Infectious Diseases (NIAID). "'Mississippi Baby' now has detectable HIV, researchers find." ScienceDaily.  July 10, 2014.

Sáez-Cirión, A.; Bacchus, C.; Hocqueloux, L.; et al. "Post-Treatment HIV-1 Controllers with a Long-Term Virological Remission after the Interruption of Early Initiated Antiretroviral Therapy ANRS VISCONTI Study." PLoS Pathology. March 14, 2013; 0(3):e1003211.

Hütter, G.; Nowak, D.; Mossner, M.; et al. "Long-Term Control of HIV by CCR5 Delta32/Delta32 Stem-Cell Transplantation." New England Journal of Medicine. February 12, 2009; 360:692-698.

Mascolini, M. "HIV Rebound Detailed in Two Boston Stem Cell Transplant Patients." 21st Conference on Retroviruses and Opportunistic Infections (CROI). Boston, Massachusetts; March 3-6, 2014.

Leung, M. "HIV resurfaces in Canadian child after break in drug treatment." CTV News. May 4, 2014.

Crowell, T.; Gebo, K.; Blankson, J.; et al. "Hospitalization Rates and Reasons among HIV Elite Controllers and Persons With Medically Controlled HIV." Clinical Infectious Diseases. December 15, 2014; doi: 10.1093/infdis/jiu809.

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