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People who “control” HIV, more susceptible to diseases

Picture of Tina Gutiérrez
Tina Gutiérrez

People ‘HIV controllers’ may be more susceptible to non-AIDS-related illnesses compared to people who are being treated for the infection, a new study has revealed.

People living with the virus who do not need antiretroviral treatment are called “HIV controllers” – their bodies alone keep the amount of virus in their blood (viral load) low.

The research, published in the Open Forum Infectious Diseases scientific journal, revealed that these people are twice as likely to experience certain non-AIDS related health conditions, especially infections such as bronchitis.

These results raise the question of whether and under what conditions ART might benefit some controllers.

Health overview

Although people with HIV who receive antiretroviral treatment lead long and healthy lives, their immune systems often remain “on” in a state of chronic inflammation. Starting treatment soon after acquiring the virus has been shown to reduce these effects, but not completely, notes the HIV website Aidsmap.

As a result of this inflammation, many people living with HIV, especially when CD4 immune cell levels are relatively low, remain at increased risk of non-AIDS-related diseases, such as cardiovascular disease, cancer, liver and kidney problems. , as well as depression and other mental health conditions.

On the other hand, less than 1% of people living with HIV are able to keep their viral load under control without taking treatment. However, little is known about the susceptibility of these HIV controllers to developing non-AIDS related illnesses, compared to those receiving treatment.

The few previous studies that have been carried out do not show clear results. Some have suggested that controllers may be in a state of greater inflammation than people taking treatment, and therefore might be more susceptible to these conditions, while others have shown similar risks between the two groups or a lower risk between Controllers.

Study findings

The research team at Paris-Saclay University in France reviewed existing French cohort data from multiple health centers. To be included in the analysis, controllers had to have had HIV for five years or more, and had at least five consecutive viral load counts below 400 copies/ml of blood without receiving treatment.

The studied population was made up of 227 controllers and 328 people in treatment. Compared with people in treatment, controllers were more likely to be female (57% vs. 14%), of African descent (38% vs. 7%), younger (average age 45 vs. 42) and were more likely to have acquired hepatitis B (46% vs. 22%) or hepatitis C (6% vs. 3%).

The analysis considered conditions not related to AIDS, such as cardiovascular diseases, lung diseases such as pneumonia, liver diseases such as hepatitis, cancer, infections, bone conditions such as fractures, as well as psychiatric conditions including depression and suicide attempts.

During the five-year observation period, 68 controllers experienced at least one non-AIDS-related illness, compared with 62 people on antiretroviral treatment. The overall incidence rates of all possible conditions were slightly higher in controllers (7.8 events per 100 person-months vs. 5.2).

The most common events were non-AIDS-related infections, such as bronchitis, upper respiratory tract infections, gastroenteritis, and urinary tract infections, with incidence rates of 4.1 events per 100 person-months in controllers compared with 1.9 in women people in treatment.

The results showed that the risk of having any non-AIDS related condition was approximately double in controllers compared to people on treatment. In addition, the researchers found that controllers were nearly three times more likely to contract a non-AIDS-related infection.

The research team believes that their findings raise the question of whether some HIV controllers might benefit from antiretroviral treatment. Although they do not advocate prescribing treatment for all controllers, it might be considered under specific conditions, especially if CD4 cell counts in controllers drop or they lose control of their viral load.

Remember that, although HIV treatment is increasingly effective and safe, the important thing is to prevent and care. If you want to take a free HIV test or need free condoms, at AHF Latin America and the Caribbean we have them for you. Locate our offices in your country and make an appointment now.