HIV remission. The word “remission” is defined as a temporary diminution of the severity of a disease or pain. Thus, if someone who has been diagnosed with a serious disease such as HIV is in remission, or if the disease has been controlled, by implication, the person is not as ill as what they were previously.

Generally, the word is used when a relatively prolonged period of lessening or disappearance of symptoms occurs. One would then understand that the lessening or abating of symptoms would infer that the disease has not been eradicated or cured. More simply put, the person would feel a lot better due to an improvement or a subsidence. The disease is thus at a stage of becoming more manageable. Upon consulting with a health care professional, and undergoing tests, the word that is used when the virus does not show up, is “undetectable”.

People living with HIV live normal lives and can cater for their loved ones in the event of their death like any other South African by taking out life insurance for HIV positive people. The loss of a loved one is traumatic enough for the family but if there are no financial hardships after death, this is a huge help to the family, particularly if there are young children or other dependents.

However, it would be quite feasible to query whether this is a temporary period, how long it will last, and can one expect a recurrence of the symptoms. To be specific, when referring to HIV remission, the implication of the situation is when people who are HIV positive have interrupted antiretroviral therapy and have no evidence of HIV replicating in their body over time. Currently, one of the major goals of researchers and scientists is to find strategies that can lead to sustained HIV remission. HIV remission is what all patients are interested in and wish to achieve. It has been said by some patients that while HIV is not a death sentence anymore, it is still a life sentence!

One of the difficulties in the arena of HIV cure and remission, is that scientists and researchers are unable to predict what will happen when a person living with HIV stops taking the antiretroviral medications.

After pausing HIV medications, most patients experience viral rebound, and this occurs quite quickly—typically within a few weeks. However, there are lots of individuals who have more delayed viral rebound. There are some individuals whose viral rebound is delayed for months and even years. Unfortunately, there is currently no known way to predict when HIV will become detectable in the blood after a patient stops HIV therapy.

Researchers are currently working on a trial to try and predict when and if someone’s viral load will bounce back, if that person is taken off antiretrovirals. It seems apparent that the information learned from the study, called ACTG A5345, will also be used to devise new strategies for HIV remission. ACTG A5345 is an HIV remission study that is currently enrolling people living with HIV at present.

While undergoing the study, researchers will identify biomarkers that can be used to try and predict when HIV will become detectable in the blood after an individual stops HIV treatment. Once confirmed, these biomarkers will be used to predict the chances of viral rebound and create strategies to achieve long-term HIV remission.

What these subjects in the study will undergo, will initially be to have a large volume of blood drawn at the beginning of the study. They will then undergo an antiretroviral break which will be very closely monitored. They will stop HIV treatment under the intensive supervision of their study doctor, returning to the clinic twice a week for the first two weeks after ceasing therapy. so that their viral loads can be monitored and to determine HIV remission.

Once people’s viral loads go up to over 1,000 copies/mL, they will re-start their HIV medications and continue to be monitored until their viral loads become suppressed. Many people might expect to have their viral loads go back up after a couple of months while off the medications. However, some people might be post-treatment controllers whose viral loads are suppressed long-term without HIV therapy. Post-treatment controllers will be followed for an extended period.

What is of primary concern for the researchers of the ACTG A5345 study, is safety. While some might be anxious and concerned about the potential risk of stopping therapy, the subjects are assured that the kind of treatment interruption being done in this study are not the same as those that were done 10 or 20 years ago. In those studies, people were taken off therapy for long periods of time and exposed to very high levels of the HIV virus. In this study, participants are monitored intensively and thus as soon as the virus may become detectable once again, they then restart therapy. These studies and trials are monitored regularly and intensively with ongoing scrutiny to avoid the subjects from any source of potential danger.

This begs the question of how HIV remission is different from viral suppression and also from being “undetectable”.
To reiterate, HIV remission refers to the situation when people living with HIV interrupt antiretroviral therapy and have no evidence of HIV replicating in their bodies for some period. HIV remission is different from viral suppression. People living with HIV are said to be “virally suppressed” or “undetectable” when taking HIV medications that prevent HIV from replicating.

As with any situation or condition that human beings encounter throughout their lives, there will always be different reactions to the same treatment. It is thus fairly unpredictable to know how each person’s body may react or if HIV remission is attainable. There is no definitive answer in that results have repeatedly shown that most patients will experience viral rebound. The time that it will take to occur is unknown and will differ amongst the subjects, some a lot quicker than others. There is no way of knowing until it happens. Understandably, this can be anxiety provoking, but the HIV infected people are encouraged to continue to be vigilant about their sexual practices and to maintain as healthy a lifestyle as possible. Cooperation and participation in monitoring and trials is extremely important as one is regularly assessed and while there is no cure currently, the medical profession is advanced enough in assisting the infected subject.