Early treatment key to HIV remission: Study

LONDON: Starting treatment early may promote long-term control of the HIV virus if treatment is not discontinued, finds a study.

People living with HIV need to take antiretroviral treatment for life to prevent the virus from multiplying in their body. But some people, known as "post-treatment controllers," have been able to discontinue their treatment while maintaining an undetectable viral load for several years.

Scientists from the Institut Pasteur, the CEA, Inserm, Universite Paris Cite and Universite Paris-Saclay, primate model of SIV infection which allowed them to control all the parameters (sex, age, genetics, viral strain, etc.) that may have an impact on the development of immune responses and progression to disease.

They compared groups that had received two years of treatment, starting either shortly after infection (in the acute phase) or several months after infection (in the chronic phase), or no treatment.

It appears that starting treatment four weeks after infection promotes long-term control of the virus following the interruption of treatment after two years of antiretroviral therapy.

These results, published in the journal Nature Communications, highlight how important it is for people with HIV to be diagnosed and begin treatment as early as possible.

The research, composed of 30 post-treatment controllers, has provided proof of concept of possible long-term remission for people living with HIV. These individuals received early treatment that was maintained for several years.

When they subsequently interrupted their antiretroviral treatment, they were capable of controlling viremia for a period lasting more than 20 years in some cases.

"We show the link between early treatment and control of infection after treatment interruption, and our study indicates that there is a window of opportunity to promote remission of HIV infection," said Asier Saez-Cirion, Head of the Institut Pasteur's Viral Reservoirs and Immune Control Unit and co-last author of the study.

The scientists also demonstrated that early treatment promotes the development of an effective immune response against the virus.

Although the antiviral CD8+ T immune cells developed in the first weeks after infection have very limited antiviral potential, the early introduction of long-term treatment promotes the development of memory CD8+ T cells, which have a stronger antiviral potential and are therefore capable of effectively controlling the viral rebound that occurs after treatment interruption, the researchers said.