Are We Medicating Our Potential HIV Cure?

Are we killing our chances of studying those that could hold the key to an HIV cure– by listening to ‘one size fits all’ treatment recommendations: that all should be on treatment?

A few weeks ago, mainstream media reported that new research supports that those living with HIV have more benefit starting treatment early as opposed to delaying when they begin treatment, but this week research published in PLOS Pathogens, and reported on HIV Equal by David Heitz points to those individuals that do not need treatment, elite controllers, as a possible path to a cure for HIV or a preventative vaccine.

Although the actual research and explanation in the medical journal may be difficult to understand, Heitz navigates the news with authority and an announcement that researchers are pretty interested in those that never go on treatment and never get sick–elite controllers.

“We are now focusing on fully understanding all the components required to trigger appropriate activation of dendritic cells in HIV infection, which may help to induce an elite-controller like, drug-free remission of HIV in a broader patient population,” explained Dr. Xu Yu. Yu is an associate professor of medicine at Harvard Medical School. The Ragon Institute is comprised of scientists from Massachusetts General Hospital, MIT and Harvard. (source)

The interest in elite controllers remains very interesting to me. Why?  It is simple: whatever they have in their bodies to control the virus (a characteristic, per se) or at least the ability to take the major punch out of the virus on healthy cells is something I want everyone to have.

But, the only way to discover these individuals, is to see their personal viral suppression without the initiation of antiretroviral medications, and determine if they are naturally able to handle the virus via their own immune response.  Right?  The new recommendations on when to start treatment supported by national HIV/AIDS organizations says start immediately:

“does immediate initiation of ART improve individual health for people living with HIV? Today the answer came in, early, and with resounding clarity: Yes.”

So does “one size fits all” treatment plans eliminate our chance of discovering these individuals? And is it a cost that ethically outweighs the ‘wait and see’ plan (waiting to determine if someone is a controller or elite controller prior to beginning any treatment plan)?

Having standards of care is extremely important– even strong recommendations. But when doctors begin to take the individual care of a patient out of the health equation, it should be unacceptable. In this case, we could be asking researchers to find a cure or vaccine based on previous “elite controllers” that we used to be able to find… or in another words– with a blindfold on.

Am I wrong?

This is just a question that I have been wondering.