by According to a recent study conducted by scientists from Institut Pasteur, CEA, Inserm, Université Paris Cité, and Université Paris-Saclay, early treatment of HIV may play a vital role in achieving long-term remission of the virus. The study, conducted in collaboration with Institut Cochin and with support from MSD Avenir and ANRS Emerging Infectious Diseases, used an animal model to identify the optimal window of opportunity for initiating treatment that could promote remission of HIV infection.
Currently, individuals living with HIV are required to take antiretroviral treatment (ART) for the rest of their lives to prevent the virus from multiplying in their body. However, some individuals, known as post-treatment controllers, have been able to discontinue their treatment while maintaining an undetectable viral load for several years. This led researchers to investigate whether early treatment could potentially promote long-term control of the virus even after discontinuation of treatment.
The study revealed that initiating treatment four weeks after infection significantly increased the likelihood of long-term viral control following the interruption of treatment after two years of ART. These findings underscore the importance of early diagnosis and treatment initiation for individuals living with HIV. The results of the study were published in the journal Nature Communications on January 11, 2024.
The researchers drew inspiration from the VISCONTI cohort, which consisted of 30 post-treatment controllers. These individuals had received early treatment that was maintained for several years. When they stopped their antiretroviral treatment, they were able to control the virus for a period exceeding 20 years in some cases. This provided proof of concept for the potential of long-term remission in individuals living with HIV.
To further investigate the impact of early treatment on remission, the scientists conducted experiments using a primate model of SIV infection. This model allowed them to control various factors such as sex, age, genetics, and viral strain, which could potentially influence immune responses and disease progression. The groups were divided into those who received two years of treatment, starting either shortly after infection (acute phase) or several months after infection (chronic phase), and those who received no treatment.
The results consistently showed that initiating treatment within four weeks of infection, similar to the participants in the VISCONTI study, greatly enhanced viral control once treatment was discontinued. However, this protective effect diminished if treatment was initiated just five months later.
Asier Sáez-Cirión, Head of the Institute Pasteur’s Viral Reservoirs and Immune Control Unit and co-last author of the study, commented on the findings, stating, “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.”
Additionally, the researchers discovered that early treatment facilitated the development of an effective immune response against the virus. Even though the antiviral CD8+ T immune cells developed in the initial weeks after infection had limited antiviral potential, the early introduction of long-term treatment encouraged the development of memory CD8+ T cells. These cells possess a stronger antiviral potential and can effectively control viral rebound after treatment interruption.
The study highlights the significance of early treatment initiation in achieving long-term control and potential remission of HIV infection. The findings emphasize the importance of early diagnosis and access to antiretroviral treatment for individuals living with HIV, as it offers the best chance for achieving positive long-term outcomes.
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1. Source: Coherent Market Insights, Public sources, Desk research
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