Today, HIV is a manageable chronic condition thanks to advanced therapies, but the challenge remains to reduce long-term medication dependency and enhance the quality of life for those affected.
Thankfully there is new hope in the long battle against AIDS. Antiretroviral treatment soon after HIV infection promotes remission, according to a joint study carried out by researchers from the Institut Pasteur, CEA, Inserm, Université Paris Cité, and Université Paris-Saclay in collaboration with the Institut Cochin.
HIV Blood Test
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HIV treatment should start within 4 weeks of infection
Table of Contents
Some HIV-infected people have managed to stop treatment, maintaining an undetectable viral load for long periods of time, in some cases for more than 20 years. Their medical records, which were analyzed in a study called VISCONTI, show that it is possible for patients living with HIV to achieve a state of lasting remission. To better understand this phenomenon, the researchers teamed up and monitored primates infected with SIV (the virus that affects monkeys and causes immunodeficiency). They compared animals that received treatment soon after infection with those that took medication several months after infection and those that were not treated.
The analyses show that early treatment start within four weeks of infection “strongly favors viral control after treatment cessation”. This protective effect is not present if antiretroviral drugs are only taken five months later.
“We have shown the association between early treatment and infection control after treatment interruption, and our study indicates that there is a window of opportunity to promote remission of HIV infection,” explains Asier Sáez-Cirión, head of the Viral Reservoirs and Immune Control Unit at the Institut Pasteur and co-author of the study.
Early detection is crucial
The researchers also demonstrated that the immediate start of treatment after HIV infection promotes the development of an effective immune response against the virus, in particular by encouraging “the development of memory CD8 T immune cells, which have greater antiviral capacity and are therefore able to effectively control the viral rebound that occurs after treatment is stopped”.
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Asier Sáez-Cirión adds: “We observed that early treatment maintained for two years optimizes the development of immune cells. They acquire an effective memory against the virus and eliminate it naturally when the virus returns after treatment has stopped.”
For the researchers, their discovery once again emphasizes the importance of early detection and treatment of people with HIV. “Starting treatment six months after infection, the period that showed a loss of efficacy in our study is already considered too short compared to what happens in clinics today, where most people with HIV start treatment years after infection due to very late screening,” warns Roger Le Grand, director of infrastructure at IDMIT and lead co-author of the study. “The impact of early treatment will be twofold: at an individual level because early treatment prevents the virus from spreading throughout the body and preserves and optimizes immune responses against the virus; and at a collective level, because it prevents the possibility of transmitting the virus to other people,” concludes Asier Sáez-Cirión. Not to mention that patients who start treatment early may be able to forgo antivirals and with them the side effects.
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Final Thoughts
In summary, this study marks a major advancement in HIV treatment. Starting therapy within four weeks of infection could lead to remission, cutting down the need for ongoing antivirals and their side effects. This is a significant stride towards improving patient care in the battle against HIV/AIDS.
References
Passaes, C., Desjardins, D., Chapel, A. et al. Early antiretroviral therapy favors post-treatment SIV control associated with the expansion of enhanced memory CD8+ T-cells. Nat Commun 15, 178 (2024). https://doi.org/10.1038/s41467-023-44389-3
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