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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.

10 Comments Join the Conversation →

  1. Jonas Lundberg

    Whilst I normally agree with you on everything and find your articles very good and youre the top activist in this instance I differ, it is a valid question though.

    The reasoning behind putting everyone on meds immedaitely is becuase it is known how much destructiveness untreated HIV causes from increased risk of cancer to brain impairment and heart disease as well as modern treatments virtually side effect free.

    It is also very possible to continue study the body’s own hiv fighting mechanisms for the purpose of HIV cure becuase in nearly all people the virus keeps replicating and hiding out in certain reservoirs of the body, there are indeed a few studies for a cure by checking how the virus keeps replicating in HIV positive people who are on treatment and undetectable.

    Infact, by studying HIV in people on meds you can not only filter out all the other noise from the HIv related damage but also can get down to the very issue of HIV low level replication – the remaining barrier to a cure.

    One of many studies, at UCLA in Los Angeles, is to check how a cancer drug, Romidepsin acts in these HIV supressed people, in the hope of fiding a cure.


    Jonas L.
    Hollywood CA

    • Josh

      Thanks Jonas! I think you are spot on. As an HIV controller myself, I wouldn’t have known that my body was able to maintain the levels it does on it’s own at the moment (and under strict doctor supervision) has I started treatment as soon as I was diagnosed. The point of the article is that: if they are important to research, and if them being treatment naive is important to research– by putting every single person with HIV on treatment immediately, are we able to still identify them? If we are — no worries. But my asking this question for sometime now to many in the field say no or it’s more difficult. I’m playing devils advocate here to just make sure the end is justifying the means in the recommendations. If it is– great. No harm or foul in asking the question right? In no terms am I saying that individuals should not listen to the experts — my question is from a reasonable place of doing my job “as an activist” to ask questions that need an answer and aren’t being asked elsewhere. I don’t know that I saw this question other places before. So thank you for the comment, but I wanted to make sure I clarified with you my intention and reason behind the article… you rock! 🙂 thanks for the link too. I’m checking it out now.

      (in reply to Jonas Lundberg)
      • Jonas Lundberg

        You rock too Josh if I didnt say so before 🙂 and the point is well clarified. I dont work in the research field myself but I will ask two top researches the question; when you do the cure research, particularly trying to indentify ellite controllers, can you still find them after they have been put on HIV medications? Are there any types of cute research that might be hindered?
        Another good question is if ellite controllers have the ususal surge in viral load during primary infection as others and the same anti body response as non ellite controllers and perhaps they could be identified by those tests.

        (in reply to Josh)
        • Josh

          Well thank you! I agree with you 100% … and I am asking these questions, because I don’t know and I don’t know who else to ask. :)~

          (in reply to Jonas Lundberg)
          • Rob

            ^ Josh is like, “I do rock!”

            (in reply to Josh)
          • Josh

            Haha. Not true. Well sometimes I rock. But most of the time, I am tragic. lol.

            (in reply to Rob)
      • apostleshadamishe

        Josh…you are asking questions, does that mean you are NOT interested in finding the answer ??? Like the University of Miami who sent agents to see what is AMBUSH that actually KILLS the virus but refuse to talk to me ??? Like the hundreds of University of Miami patients who have taken AMBUSH for 21 days, had their viral loads reduced with a corresponding rise in CD4 and still take the FREE medication that was valued between $500 to $1500 per month and sell the medication ???? Is there a reason why any of the Governmental agencies I have approached in the last 13 years have ignored my request to even look at what I have been saying about Ambush ??? Why have those who have taken Ambush, waited for 5 months and have seroreverted to HIV NEGATIVE not made there results public knowing that it is illegal for me to say so ??? Just a few questions !!!

        (in reply to Josh)
    • apostleshadamishe

      Jonas…the scientific community uses the term ‘reservoir’ which like water means ‘the same’ at every point. This is NOT TRUE for the HIV virus. What it does is to form a cocoon wherein one virus wraps itself with say ten and the ten wraps itself with a hundred to form a tight wad of virus with many layers. These cocoons are usually formed in the lymph system or in the tendons. Hence there is very little whole blood which carries the ARVs to these areas. Even if a cocoon is found at a good supply of blood and ARV’s they are wrapped so tightly that the outer layer is impacted but there is ‘protection’ for the other layers waiting for the level of the ARV¨s to decrease and they are back in business.

      (in reply to Jonas Lundberg)
  2. Loreen Willenberg

    Hello Josh,
    A link to your blog came through on my Google alert today for “HIV Controllers” content, and I’m happy that it did. I’ve been deeply concerned about this “treat elite” issue for quite some time, and appreciate that you have posed this question publicly. In a clinical setting, the HIV+ individual whose CD4 count registers in the higher ranges of normal (750 to 1400 for example), along with a high CD4:CD8 ratio (45-53%, for example), and an “undetectable” viral load (less than 20 copies/mL, for example) provides a very good clue right off the bat that the individual may very well be a member of the elite controller community. Research findings from the past decade or so (International HIV Controller Study, Ragon Institute, National Institutes of Health, Pasteur Institute, among others) suggest that a small sub-set of elite controllers are indistinguishable from HIV-negative individuals. The same holds true for the overlapping phenotype of Long-Term Nonprogressors (LTNPs), as indicated by Dr. Stephen A. Migueles and Dr. Mark Connors, Principal Investigators of the NIH LTNP Study at the Laboratory of Immunoregulation of the NIH. I’m glad you have launched what I hope becomes a public debate on the necessity of ART for rare individuals who are, within all norms, clinically healthy. Stay tuned for more of my thoughts on this subject, coming soon on a platform yet to be decided.

    Well done, Josh. Thank you!

    With my best wishes,
    Loreen Willenberg
    Founder, Zephyr LTNP Foundation, Inc.

  3. Riddley Daniel

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