Would "HIV Controllers" Benefit from Antiretroviral Therapy?

April 8th, 2014

Would “HIV Controllers” Benefit from Antiretroviral Therapy?

Let me start with a disclosure — I’m the co-PI (along with Jon Li and Florencia Pereyra) on a study addressing the very question in the title.

The reason for this post is that the topic has been the beneficiary of some terrific coverage in Nature Medicine, both of this research question specifically and the whole topic of HIV controllers in general. Highly recommended.

Everyone who practices HIV medicine has encountered at least one of these lucky few who have low or even undetectable blood HIV RNA without antiretroviral drugs. And as you know, these HIV controllers represent a small subset of those with HIV — estimates vary, but it’s almost certainly < 1%.

Our message to them for years was that they didn’t need treatment, because they are already doing essentially the same thing with their own immune system.

But now there’s a body of evidence that this HIV control may have a downside, specifically an excess of immune activation and inflammation — which can, over the long term, have adverse effects on health. Cardiovascular disease (here and here). Lymphoid fibrosis. And a surprising report at CROI this year found a higher rate of hospitalization among HIV controllers compared to a control group of HIV patients who are receiving ART.

So would HIV controllers benefit from HIV treatment? That’s what we’re trying to answer — more details of the study, ACTG A5308, right here.

And if you have a few minutes, listen to this interview from Nature Medicine. It’s chock-full of thoughtful questions, and my best attempt to answer them!

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April 8th, 2014