Whilst there isn’t yet a cure for HIV, the virus can go into ‘remission’. This is where the virus is suppressed for a short time by the immune system without the need for antiretrovirals (ARVs). This period of time could be months or years. The majority of people do not undergo remission and for those who do, it is usually from exceptional circumstances.
If an HIV-positive patient reliably takes their ARTs then the virus remains suppressed in hidden reservoirs that are difficult for drugs to reach. (the brain, nerve endings etc). As soon as the patient stops taking ARTs, the virus leaps back into action and begins to replicate, venturing out of the organs where drugs can’t destroy it and multiplying all over the body.
However, there are some cases where the body’s immune system could suppress the virus for a while after ARTs were stopped. This period is called remission. Remission can last for months, and in rare cases, years. (0) Not everyone experiences remission, in fact it is quite rare and thus each case is studied carefully.
Case Studies
The Mississippi baby was born in 2010 to an HIV-positive mother. The infant received antiretroviral therapy very early into the infection, within thirty hours of being born. After the baby’s ART regimen was interrupted later in life, the virus amazingly did not return. For just over a year, the Mississippi baby lived HIV-free; however, the virus did eventually return. It is thought that the early administration of ARTs aided the long period of remission. (1)
A ten-year-old South African child, diagnosed with HIV from birth, stopped taking ARTs from ten-months old. Since then, the child has been asymptomatic and has no virus in the blood. However, with careful study and specific tests, symptoms of the virus can be found indicating that it may come back at some point in the future. (2)
Two patients, ‘the Boston patients’, who were HIV positive had bone marrow transplants to treat conditions that weren’t related to HIV/AIDS. A bone marrow transplant does a factory reset on the body and the two patients tested HIV negative. However, after a year, the virus returned. (3)
There is one case of the virus staying in remission over ten years after a bone marrow transplant. The HIV-positive patient, Timothy Ray Brown, had a stem cell transplant for leukaemia, cancer of the bone marrow and blood. Due to a rare gene-mutation in the donated stem cells, the HIV in his body was eradicated even in reservoirs where it likes to hide. Brown is the only patient considered ‘cured’ of HIV and the details of his unusual case can be found here.
HIV Remission
The advantages of remission is that it gives the patient a breathing period where they aren’t taking pills for a while and can relax. However, not everyone experiences remission and HIV-positive patients are advised against coming off their ARTs to see if they go into remission.
It is thought that remission may be a sort of halfway house between treatment and a cure. While cures are being researched, scientists are still far off beating HIV so in the meantime, HIV-positive people are advised to continue taking their ARTs.
References
(0) Remission – The period during which symptoms of a disease diminish or disappear.
https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/626/remission
(1) Mississippi Baby –
https://www.viivhealthcare.com/inside-viiv-healthcare/part-1-what-does-cure-and-remission-mean-in-hiv.aspx
(2) South African Child –
https://www.medicalnewstoday.com/articles/318636.php
(3) Boston Patients –
http://www.aidsmap.com/The-Boston-patients-experience-HIV-rebound-after-stem-cell-transplants/page/2833963/
Written by Caroline Reid
