colleague, Dr. Joel Blankson, an African-American physician-scientist working at Hopkins and one of the leading experts on HIV Elite Controllers.
Post-Treatment Controllers
In the previous article, I introduced the concept of the functional cure. A functional cure means that the person’s immune system is controlling the virus without any treatment. There could possibly be a virus hiding somewhere in the body, but it is not able to cause much damage. There are patients who have been treated with HIV medicines and after the medicines suppress the virus to an undetectable level, the patients stop taking medicines and remain suppressed or undetectable.
This phenomenon is not that unusual. It is referred to as Post-treatment control. It is most commonly seen when patients are started very early (within a few weeks to months after infection) on strong combinations of HIV medicines. The reason we think it happens more commonly with very early treatments is (1) The virus has not caused as much damage to the immune system as occurs in someone infected for a longer duration without treatment and (2) there is less virus in certain hiding places in the body where the HIV medicines may not get to as easily.
These hiding places are called reservoirs. I remember seeing a patient around 2006 who might be termed as a functional cure. She was diagnosed a few weeks after being infected and was immediately started on a powerful combination regimen including a protease inhibitor. She was soon undetectable. After about 6 months of being undetectable, her medicines were stopped (not sure exactly why). She remained undetectable. At the time I saw her, she had been undetectable off medicines for about three years.
At the HIV Cure conference held at the NIH in Bethesda MD in October 2018, some interesting findings were presented from the CHAMP study (Control of HIV After Antiretroviral Medication Pause). The purpose of the study was to determine how common post-treatment controllers are and what are the factors that lead to this level of control. Because Post-treatment Controllers are not common, this study recruited subjects from a number of different, separate studies. Patients who were on HIV medicines and undetectable stopped taking their medicines and were monitored frequently.
When virus became detectable in the blood above a certain level, they were started back on medicines. In total. out of more than 700 patients who participated in the study and had their medications stopped, 67 of them remained suppressed. Out of those 67 successes, 38 had started treatment very early after