MedPage Today (03.04.13)
University of California at San Francisco researchers report that giving highly active antiretroviral treatment (HAART) to HIV “controllers”—people who maintain low levels of HIV plasma RNA without antiretroviral treatment—significantly reduced plasma RNA and chronic inflammation markers. Dr. Hiroyu Hatano stated the research team began the prospective 16-person study because the controllers showed signs of immune system activation and increased atherosclerosis.
Although members of the cohort had HIV for a median duration of 10 years, the participants had “robust” immune systems; the median plasma HIV RNA level was 77 copies per milliliter, and the median CD4 count was 615 cells per cubic millimeter of blood. Hatano reported that the cohort received raltegravir (Isentress) and a one-pill combination of tenofovir and emtricitabine (Truvada) for 24 weeks.
Variables measured in the study included plasma and cell-associated HIV RNA, proviral DNA in blood and gut-associated lymphoid tissue (GALT), and immune activation markers. Results indicated a significant decline in plasma HIV RNA and decreases in cell-associated RNA and GALT proviral DNA.
Scott Hammer, MD, co-chair of the 20th Conference on Retroviruses and Opportunistic Infections, declared that the finding would be unlikely to affect clinical practice because controllers do not ordinarily receive HAART, and there are other ways to control atherosclerosis. Taking HAART might upset the “delicate balance between the immune system and the viral load” of a controller. According to Hammer, pregnancy would be the only reason to give HAART to a controller.
Hatano said most of the study participants have opted to continue HAART, so it will be possible to report results after a longer period of treatment.
An abstract of the full report, “Prospective ART of Asymptomatic HIV+ Controllers,” was published online by the 20th Conference on Retroviruses and Opportunistic Infections at