Early therapeutic intervention may be instrumental in HIV control - French study
The work published on March 13th in PLoS Pathogens describes the control of HIV infection after early treatment of 14 patients who have been off therapy for 7.5 years (the cohort ANRS EP47 VISCONTI).
This work suggests on a larger and durable scale what the functionally cured “Mississippi baby” case potentially indicates: that early therapeutic intervention may be instrumental in HIV control and has important implications for HIV cure research.
It is known that following acute infection, HIV establishes viral reservoirs in long-lived cells which allow its persistence even after prolonged treatment. As a consequence, viral replication readily restarts at pretreatment levels upon treatment interruption in most patients.
However, few patients treated very early in primary infection are able to control infection after treatment interruption. The initial observation of patients controlling HIV was made in France by Dr Laurent Hocqueloux (Orleans-La Source Hospital) and in the ANRS CO06 PRIMO cohort (this cohort is a long term survey of newly infected patients).
The ANRS decided in 2009 to setup and fund a multidisciplinary team of researchers and to assemble a cohort of such patients to characterize this phenomenon. The ANRS EP 47 VISCONTI cohort (Viro-Immunologic Sustained COntrol after Treatment Interruption) is a group of 14 patients who have maintained virological control of their HIV infection for a median time of 7.5 years after the interruption of antiretroviral therapy.
All these patients were diagnosed during primary infection and were immediately treated (within ten weeks after infection) with antiretroviral drugs, for a median time of three years before treatment discontinuation. The ANRS EP 47 VISCONTI study is coordinated by Prof. Christine Rouzioux (Necker Hospital and University Paris Descartes, Paris), member of the initial team who identified HIV 30 years ago, and Dr. Asier Sáez-Cirión (Institut Pasteur, Paris), senior researcher in the lab of HIV co-discoverer and Nobel Prize Laureate Pr. Françoise Barré-Sinoussi.
Although most patients will not be able to control HIV, the data presented in the ANRS EP 47 VISCONTI and the Mississippi study strongly support early treatment initiation and may hold important clues for the development of a strategy to cure HIV or at least, induce a long-term control without the need of antiretroviral treatment. “Current efforts are focused in understanding why only a fraction of patients treated in primary infection are able to control infection and what are the mechanisms responsible for viral control in these post-treatment controllers.
A European cohort constituted of Post-treatment Controller patients will start in the next few months, coordinated by the ANRS”, says Pr Jean-François Delfraissy, Director of the ANRS.