HIV Remission Cases Capture the Imagination of Specialists: Eight Years and Still Counting

The ravaging nature of HIV have constantly been documented in literature since the detection of the RNA virus that has defiled all possible treatment attempts. The modalities of spread of the deadly disease are well recognized and controlling the spread from mothers to child gave rise to PMTCT. However, the significant burden of the disease continues to be worrisome looking at Africa's health index.

Recently, a report that a 9-year-old South African girl has had an undetectable HIV viral load since she stopped treatment more than 8 years ago calls for celebration as this could open up more research into the disease and may signify tanking of virulence in African decents. However, similar remission cases have been documented in a patient in San Francisco who began treatment days after infection and achieved sustained remission for 7.4 months, after which the virus rebounded. Also, in a 24-year-old Thai man who had an undetectable viral load for 3 years before being enrolled in the RV397 vaccine trial. Despite recent detectable viral loads in the Thai patient, his remission has been sustained for 10 months. The Africa index case is surely the longest recorded case of remission.

These remission cases data underscore the importance of early detection of acute HIV cases and early treatment which is hoped that quick institution of treatment/post-exposure prophylaxis would make these rare remissions regular occurrences in our practice. At the moment, it remains unclear if immunologic response has a role in viral rebound and viral remission or just a showcase of mutated virus. Some authorities theorized it could be due to difference in immune activation among patients.

It's noteworthy that remission remains clinical question hence, patients on Anti-Retroviral Therapy (ART) must not stop treatment.
Physicians can help patients improve their likelihood of remission by explaining why the initiation of therapy as early as possible after infection is beneficial for now, and how that could set them up for remission later, if researchers succeed in finding a way to harness these rare remissions into a useable strategy.

The cost implications of HIV is enormous and we must all be involved in stamping out this menace. Remember your ABCs = Abstinence! Be faithful! Condoms!