Treating HIV-infected elite controllers as a model of HIV remission
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Although HIV medicines are very effective in decreasing death and disease in individuals infected with HIV, it is clear that these medicines do not completely restore the health of HIV-infected individuals to normal levels. This limitation is of particular concern among older HIV-infected adults (who are overrepresented in California, given the age of the HIV epidemic in this state). Perhaps the only way to address this limitation is to study the possibility of removing HIV from infected individuals. While complete removal of HIV may never be possible, a “functional cure” in which patients are able to control HIV without medicines may be possible. The best evidence for this is a group of HIV-infected individuals called “elite” controllers. Controllers are infected with HIV, but are able to control their infection for long periods of time without HIV medicines. They may be thought of as a naturally occurring model of “HIV remission." because they are able to control their HIV infection for long periods without medicines. Although rare, they are ideal individuals in which to study: 1) how to control HIV without medicines; 2) how HIV persists in the body; and 3) how to remove HIV from the body. In the following studies, we will first determine how much virus controllers have in their bodies. We will then give a standard combination of HIV medicines to a small number of well-characterized controllers. Our short-term objective is to make sure that this is safe and feasible. Our long-term objective is to provide preliminary data for additional studies which will be aimed at the goal of eradicating HIV from the body. More specifically, our study goals are to: (1) determine the amount of virus in different compartments of the body in 10 untreated controllers; and (2) then treat these 10 controllers with a group of well-tolerated HIV medicines (raltegravir, tenofovir/emtricitabine) for 6 months and study how treatment affects the amount of virus in the different compartments in the body. Our primary hypothesis is that untreated controllers have virus in their bodies, and that treatment with HIV medicines will reduce the amount of virus. Our secondary hypothesis is that levels of inflammation in the body (which are thought to be driven by HIV) will decrease with HIV treatment. We believe our study will be informative to the many groups now working on developing a “functional” cure for HIV. For example, if untreated controllers have virus in their bodies and if the level of virus decreases with HIV treatment, then this would suggest that total removal of HIV is not necessary to achieve effective, long-term control of HIV. On the other hand, if untreated controllers do not have detectable virus in their bodies and/or the level of virus does not decrease with HIV treatment, it would suggest that controllers have successfully shut-down HIV on their own. Future studies could then examine what immunologic mechanisms are responsible for this control.