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.” For a cure, no HIV can be found in the genetic information in the patient’s cells.
Just a short time 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 treated 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.
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.
Some researchers believe that if treatment starts early enough, it will prevent a reservoir of HIV and further treatment may not be needed. There are reports of long remissions in children who've done this.
One case 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. She was still in remission 14 years later.
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. It's a must for living your longest, healthiest life.
Is a Cure Possible?
You may have heard of the “London patient” and the “Berlin patient” as having been cured of HIV. But their cases aren’t the same as HIV remission, as they both had blood cancer and got stem cell transplants from people who had a genetic resistance to HIV.
Both were dealing with another condition -- a blood cancer that wasn’t helped by chemotherapy -- as well as having HIV. They both got stem cell transplants from people who had a genetic resistance to HIV. The goal was to treat their cancer and also target their HIV.
Stem cell transplants aren’t likely to become a common treatment for HIV, because they can have dangerous side effects.
The London patient, who is anonymous, had no signs of HIV after the stem cell transplant. The patient stayed on antiretroviral medications for 16 more months. After stopping those medications, the patient still had no sign of HIV 18 months later.
Timothy Ray Brown is the “Berlin patient.” He’s an American who was living in Berlin when he 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.
Brown’s 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, his cancer came back and he needed a second transplant from the same donor. Brown is now cancer-free and has no detectable HIV in his body, even though he's been off treatment since 2007.
Scientists had tried for years to make the same treatment work again. It didn’t for almost a dozen years. But the fact that it has worked twice has researchers working hard to understand what the key is and how it might help other people.
There has recently been a single case of a man who has been in long term remission after taking "highly intensified" antiretroviral treatment without having a stem cell transplant.
More research is ongoing to see if this can happen in others who are treated the same way, and to see how long this remission may last.
Also, attempts are now being made to boost the immune system to achieve long term HIV remission using broadly neutralizing antibodies, or bNAbs. Other ways to help the immune system that are being investigated include using antibodies that bind to parts of the immune system and priming killer T-cells to kill HIV infected cells.