Early treatment and ‘functional cure’

Doctors in France have found that 14 people who started antiretroviral therapy very soon after they were infected with HIV are now controlling the virus without taking anti-HIV drugs. In a journal article about the case, the doctors refer to the people as being in virological ‘remission’. Researchers sometimes also call this kind of response a ‘functional cure’.

The ten men and four women were infected with HIV and started immediate antiretroviral therapy between 1996 and 2002.

They remained on treatment for an average of three years. They then stopped treatment and have remained off treatment for an average of 7.5 years.

All 14 have maintained an undetectable or very low viral load. In eight people, viral load has remained undetectable; the others had occasional periods of low but detectable virus.

The average CD4 cell count at the time treatment was stopped was approximately 900. It has since fallen to around 830, but in five people it has actually increased.

Researchers also examined HIV DNA levels within the cells of eight people and in five of them, it fell even after stopping treatment.

The researchers think that up to 15% of people living with HIV who start very early treatment and stay on therapy for at least a year may be able to maintain long-term control of HIV after stopping their treatment.

They believe their findings support the use of very early HIV treatment. 

Last month, doctors in the US reported the case of a baby infected with HIV at birth whose HIV was ‘cured’ by very early triple therapy.

Early HIV treatment has also been shown to limit the size of the ‘reservoir’ of cells with latent HIV infection.

All these findings will offer hope to both people living with HIV and doctors that, in some circumstances, antiretroviral therapy may not need to be life-long.

However, currently only a small number of adult patients start treatment very soon after they are infected with HIV. More research is needed to see if this can lead to long-term control of HIV once therapy is stopped.

HIV and cardiovascular disease

Infection with HIV is associated with an increased risk of heart attack, according to the latest US research. Overall, infection with HIV increased the risk of heart attack by about 50%.

The findings of the study are especially important because doctors compared the risk of heart attack between HIV-positive and HIV-negative people with very similar demographic and cardiovascular risk profiles.

Cardiovascular disease is an increasingly important cause of serious illness and death in people with HIV. The reasons for this are controversial, but seem to include a number of factors, including traditional causes such as smoking and diet, as well as the damage caused by untreated HIV infection and the side-effects of some antiretroviral drugs.

Researchers from the US wanted to get a clearer understanding of the risk of heart attack associated with HIV infection.

They looked at the medical records of 27,350 HIV-positive and 57,650 HIV-negative people. They were well matched in terms of age and race, and also had very similar cardiovascular risk profiles.

Despite this, people with HIV were approximately 50% more likely to have a heart attack.

The association between HIV and an elevated risk of heart attack persisted when the researchers took into account factors such as hepatitis C co-infection, smoking and obesity.

The risk of heart attack was highest for people with a low CD4 cell count and a detectable viral load. But even people with a low viral load had an increased risk of heart attack.

The researchers believe their findings have important implications for assessing cardiovascular risk in people with HIV.

Risk of cardiovascular disease was assessed using the Framingham score, which calculates individuals’ ten-year risk. The investigators believe that the Framingham score may not accurately reflect the true risk of heart attack and other cardiovascular diseases within the context of HIV infection.

Hepatitis C

Even low levels of alcohol consumption are harmful for people living with hepatitis C, new research has shown.

US doctors found that having just one or two drinks each day increased the mortality risk for people with hepatitis C.

Hepatitis C is an increasingly important cause of serious illness and death in many countries. The importance of alcohol consumption to disease progression has been uncertain.

Therefore a team of doctors looked at information gathered between 1988 and 1994 and looked at the impact of moderate (up to two drinks a day), excessive (three drinks per day) and heavy drinking (above three drinks per day) on mortality risk for people with and without hepatitis C.

Overall, people with hepatitis C had a much higher mortality risk than the people who did not have hepatitis C.

Alcohol consumption added to this risk, with even moderate levels of drinking associated with the doubling of the risk of death.

The study’s authors believe that people with hepatitis C should be advised to abstain completely from drinking alcohol.