What Is HIV Remission?

Remission means living disease-free after you stop treatment. The cause of your disease isn't necessarily gone, but your immune system is able to control it. Scientists haven’t exactly agreed on a definition of “remission” as it applies to HIV (human immunodeficiency virus) -- the virus that causes AIDS.  But it generally means that HIV viral load has remained undetectable after HIV treatment has been stopped.  It falls short of a “cure,” which also means that no HIV can be found in the genetic information in the patient’s cells. Thus far, only one patient has ever been documented to be “cured” of HIV.

Just a few years ago, doctors didn't think that "remission" could happen with people infected with HIV. But this may be changing.

In rare cases, people have been able to control the virus and live well long after they quit HIV medications. Doctors and researchers hope to make it a reality for more than just a handful of people.

HIV: A Sneaky Virus

A combination of drugs (called antiretroviral therapy, ART) can keep HIV from making copies of itself. It protects your immune system and stops the progression to full-blown AIDS. But it can't get rid of all the HIV.

People who are successfully treatmed have very low levels of virus in their blood. If you start ART at the right time and follow your doctor's orders, you can expect to live for many years. But you'll probably need to be on the drugs for the rest of your life.

Some people can't pay for the medications, and others don't want to stay on them because of side effects, such  nausea, diarrhea, and dizziness. But if you quit treatment, the virus usually comes back within weeks. 

That's because pools of HIV are "asleep" in your body. When you stop taking the drugs, this so-called "latent HIV reservoir" wakes up and gives new life to the infection.

Early Treatment

Researchers believe you need a small HIV reservoir and a strong immune system to go into remission. Many think starting medication soon after infection can protect immune cells from damage and stop HIV from setting up a big reservoir.

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It's estimated that between 5% and 15% of people who use therapy early can control their virus after they stop treatment. There are reports of long remissions in children and adults who've done this.

One of the latest cases is a young woman from France who was born to a mother with the virus in 1996. She tested HIV-positive and got strong ART at 3 months old. The girl was on therapy until she was 6 years old but then stopped.

When doctors tested her a year later, they didn't find any virus in her blood. She stayed off treatment. More than 14 years later, she's still in remission. It's the longest one recorded so far.

Her cells still hold some fragments of HIV, so it could come back -- she's not considered cured. She and others in remission are routinely tested so if they relapse they can start therapy again.

If you find out you're HIV-positive, talk to your doctor about starting treatment as soon as possible. And stay on the medicine. Doctors warn that only people in research studies should drop out of care.

The Berlin Patient: Is a Cure Possible?

Scientists are studying the man known as the "Berlin patient" -- the only person believed to have been cured of HIV.

Timothy Brown, an American living in Berlin, tested positive for HIV in 1995. He started ART and lived with the virus. Eleven years later, Brown faced another health crisis. This time it was the blood cancer leukemia. To survive, he needed a stem cell transplant -- a treatment that replaces unhealthy blood cells with normal ones.

His doctor suggested a transplant from a rare type of donor: a person with genes that make immune cells that are resistant to HIV. The doctor hoped this would cure the cancer and the HIV.

Brown stopped taking ART the day of the transplant. A year later, the cancer came back and he needed a second transplant from the same donor. Brown is now cancer-free and has no detectable virus in his body even though he's been off treatment since 2007.

Stem cell transplants can have dangerous side effects, so they're only used in people with certain cancers. Doctors have tried to repeat the success on others but haven't been able to so far.

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Outlook

People who have gone into remission -- and the Berlin patient, who appears to have been cured -- have scientists hopeful they can find a cure for HIV. One key is to find where the virus hides in the body and then shrink or get rid of the reservoir. Researchers are working on different ways to do that.

If you do have HIV, keep taking your medication. It is possible to live a relatively normal life and have a normal life expectancy if you maintain treatment.

 

WebMD Medical Reference Reviewed by Jonathan E. Kaplan, MD on June 20, 2017

Sources

AIDS.Gov: "Changing or Stopping Treatment," "Overview of HIV Treatments," "Side Effects."

AmfAR -- The Foundation for AIDS Research: "Post-Treatment Controllers: Pathway to a Functional Cure?"

Ananworanich, J. Current Opinion HIV/AIDS, January 2015.

AVAC: Global Advocacy for HIV Prevention: "Living Below Detection: Another case of HIV Remission."

AVERT: "Working in Healthcare and HIV."

Steven Deeks, MD, HIV researcher; professor of medicine in residence at the University of California, San Francisco and a faculty member in the Positive Health Program (AIDS Program) at San Francisco General Hospital.

Elizabeth Glaser Pediatric AIDS Foundation: "HIV 101: Understanding HIV."

Fred Hutchison Cancer Research Center: "Timothy Ray Brown: the accidental AIDS Icon."

Institut Pasteur: "First case of prolonged remission (12 years) in an HIV-infected child."

National Institutes of Health AIDS Info: "The Basics of HIV Prevention," "Latent HIV Reservoir."

San Francisco AIDS Foundation: "Long-term HIV Remission Case Raises More Questions than Answers."

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