Most of you may have already heard/ read/ watched Saez-Cirion's presentation on Monday 20th July where he presented data on a new post-treatment controller. To recap:
Born at 37(+5d)/40 and mum on mono ddC since 13/40 with uncontrolled viremia 4.63M RNA copies, CD4 T-cells 81 and CD4/8 ratio 0.16. Baby was given ZDV prophylaxis immediate, RNA was undetectable at d3 and DNA ind at d3, d14 then positive at W4. ZDV was unfortunaelt interrupted at W6 and HIV-RNA reached a peak of 2.1x106 copies/ml at 3 months of age when cART (zidovudine, lamivudine, didanosine, ritonavir) was initiated. HIV-RNA was undetectable one month later and remained below assay-detection limits while on cART, except at 15 and 21 months of age. Between 5.8 and 6.8 years of age cART was discontinued by the family but HIV-RNA was undetectable when the child returned to clinical care at 6.8 years of age and cART was not resumed. HIV-RNA has remained < 50 copies/ml for more than 12 years except for 2 blips. This was not due to HLA type and raised the possibility if a defective provirus or an immune mediated phenomenon.
Locally in Melb, we've seen a few unique post treatment controllers and elite controllers recently and are currently interested in exploring their immunological, virological and HLA features. You may have seen a few in your practice too and we'd be interested to hear from you.
There was also some debate about the role of structured treatment interruption in this meeting. See also "ultrastop" data (Katlama). Should we risk-stratify? Do we know how to risk-stratify? Is it safe? How closely should we monitor? Is it necessary?