New studies demonstrate that when people are treated at the very early stages of an HIV infection (during the acute infection phase), the virus remains under control in some of them, even after they stop treatment. This is called ‘post-treatment control’. The NOVA study by the H-TEAM investigates the effects of this very early treatment on the characteristics of the immune system and the virus. These insights support the development of new treatment strategies which will ensure that HIV-infected people no longer need antiretroviral therapy (ART) over a long period of time and can suppress the virus by themselves without ART. For this research the H-TEAM collaborates with hospitals all over the Netherlands.
The study aims to learn about the effects of starting ART as quickly as possible after being diagnosed (during the acute infection phase) on the viral load in cells in the blood, lymph nodes, intestines and the central nervous system (the HIV ‘reservoir’), and the general immune response to the virus. This might result in starting points for new treatment methods which could mean that people living with HIV no longer need to take HIV medication every day.
Currently available ART treatment can suppress the multiplication of the virus, resulting in a partial recovery of the immune system. When people start this treatment, they must adhere to it for the rest of their lives, because if they would stop the treatment, the virus would quickly come back.
Challenges of lifelong ART treatment include side-effects, high costs, stigmatisation and limited availability of ART (in developing countries). That is why investigating new treatment methods that could ensure patients can suppress the virus without taking ART are important. Reaching such a condition is called ‘post-treatment control’.
Presently, we don’t exactly understand what factors might result in ‘post-treatment control’ and we cannot easily predict which patients will benefit most from such treatment in future. The H-TEAM’s NOVA study investigates this, as well as what parts of the immune system are crucial to this process in patients who start treatment during the acute infection phase.
The study focuses on people living with HIV in the acute infection phase. This phase comprises the first weeks after the infection takes place. Identifying an acute HIV infection is of great importance as recent studies demonstrate that starting ART in this phase improves the prognosis of patients in the long run.
In addition, there is an elevated chance of transmitting the virus during this first period, in part because the blood contains a very high viral load. To enable fast diagnosis, referral, treatment and participation in the research, the H-TEAM introduced a new fast acute HIV diagnostic service at the GGD and the Diagnostic Centre (DC) clinics. The www.hebikhiv.nl website gives information about symptoms of an acute HIV infection. When people realise thanks to the website or by other means that they may have the symptoms of an acute HIV infection, or when, for example, a general practitioner believes a person might have an acute HIV infection, they can visit the acute HIV service of the GGD or one of the DC clinics. They can then have a standard HIV test combined with a rapid sensitive RNA test the same day. If somebody actually appears to have an acute HIV infection, the patient can start treatment that same day in one of the treatment centres in Amsterdam. After that, they will be asked to participate in the NOVA study, and they will subsequently be included in the investigation.
The NOVA study started in August 2015 and at the moment (mid 2017) nearly 60 patients are participating in the research. To date (February 2017), some 250 people were tested, seventeen people were diagnosed with an acute HIV infection, and two with a chronic HIV infection.
Nearly all of these patients started HIV treatment that same day, and after two months the majority of them had an undetectable viral load. We expect the first research results of this group in the coming years.