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IrsiCaixa links more aggressive variants of HIV to an increased number of rapid progressions to AIDS

  • Researchers from the Institute for AIDS Research IrsiCaixa, jointly funded by "la Caixa" Foundation and the Catalan Government’s Department of Health, describe the characteristics of some more aggressive variants of HIV, that are increasing the number of rapid progressions to AIDS.
  • One of the main characteristics described in the study, which will be published in the printed version of the journal AIDS on June 1 (already available online), is that these aggressive variants of HIV are adapted to the more common genetic profiles in the population, which limits the response of the immune system of the patients and favours rapid progression to AIDS.
  • IrsiCaixa researchers are already working to find clues that will allow identifying these aggressive variants, to provide an early diagnosis of rapid progression to AIDS. Early treatment in these patients should help to improve poor immune recovery observed in these patients.
  • These data explain the evolution of the HIV pandemic in Europe. Scientists state: “We have observed that HIV is slowly turning itself stronger. It is necessary to reinforce prevention policies of HIV and facilitate access to early detection and treatments”.

 

The first cases of AIDS were reported in the early 80s. Through decades of research, and despite not having a cure for HIV infection yet, antiretroviral therapy has demonstrated a high level of success, contributing to increase both life expectancy and quality of life in HIV-infected people. HIV infection can turn to be chronic, as soon as there is early detection, access to treatment and well adherence.

 

However, some groups of patients present responses to treatment out of the standard. The so-called elite controllers manage to stop the replication of HIV in absence of treatment. On the other side, others present an unusual rapid progression of HIV infection, developing AIDS before the end of the third year after infection. This situation can cause severe health complications and, in some cases, the death.

 

Researchers are trying to determine which characteristics of the HIV and which features of the immune system of people living with the virus influence in each type of response to HIV infection. But few studies before had focused in the rapid progression of HIV infection, and they have been limited to the report of particular cases.

 

This week, researchers from the Institute for AIDS Research IrsiCaixa, jointly funded by "la Caixa" Foundation and the Catalan Government’s Department of Health, have taken a further step forward in the understanding of rapid progression of HIV infection, paving the way to improve the clinical management of these patients.

 

As they will publish in the printed version of the journal AIDS on June 1 (already available online), there are some more aggressive variants of HIV in circulation, which cause increased numbers of rapid progressors. In this article, scientists have described a set of characteristics of these viral variants.

 

The study has been made in collaboration with researchers from the University of Lausanne, University of Bern, Universidad Complutense de Madrid, eMonogram Biosciences, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), and the Banc de Sang i Teixits.

 

More aggressive variants of HIV in circulation
The results suggest that HIV is adapted to the more common genetic profiles in the population, limiting the response of the immune system in these patients and favoring rapid progression to AIDS, causing health complications and, in some cases, death. This explains the evolution of the HIV pandemic in Europe: scientists state that HIV is slowly turning itself stronger.

 

According to the study, the characteristics of the HIV play a more important role in rapid progression than previously thought. Researchers have found some common features in these aggressive variants of HIV: they are able to infect a wider range of cells, they replicate faster and they present mutations that make them invisible to the immune system, limiting the capacity to develop an early, fast and effective immune response.

 

Need to reinforce prevention messages and facilitate access to treatment
Rapid progressors not only show a poorer immune response to HIV, but also they do not recover as it is expected after the initiation of treatment. For this reason, researchers recommend “to start antiretroviral treatment as soon as possible in case of rapid progression”, explains ICREA Research Professor at IrsiCaixa Javier Martínez-Picado, co-senior author of the study.

 

But to certify a case of rapid progression, experts need to know when transmission occurred, which it is often difficult to determine. And moreover, such test does not exist yet. However, IrsiCaixa researchers are already working to find clues that will allow the early diagnostic of rapid progression to AIDS. “If we manage to identify cases of rapid progression and start treatment early, we will have more chances to succeed and help patients to recover”, he adds.

 

In a previous study in 2011 lead by IrsiCaixa, 8% of patients with a known date of infection had  rapid progression after HIV infection, before the 3rd year. And, in the present study, they have observed that 63% of these kind of patients developed a rapid progression even before the end of the first year after infection.

 

According to their data, Julia García-Prado, Miguel Servet fellow at IrsiCaixa and co-senior author of the study, highlights that “the aggressiveness of these variants is due to the fact that the HIV that infected those people were already adapted to human immune response”. “In this context”, she says, “prevention acquires an even higher role to halt the transmission of these variants and control the HIV pandemic”.

 

Scientists speculate with the idea that the virus will replicate and mutate in people who are unaware of their infection and therefore not taking antiretroviral drugs, or they might know they are infected but are not taking their drugs properly, thus contributing to turn treatments ineffective. This scenario will facilitate the transmission of an adapted virus to a new person, whose immune system will fail to control the virus if he/she is genetically similar.

 

 

Reference:
Judith Dalmau, Margalida Rotger, Itziar Erkizia, Andri Rauch, Pedro Reche, Maria Pino, Anna Esteve, Eduard Palou, Christian Brander, Roger Paredes, Pham Phung, Bonaventura Clotet, Amalio Telenti, Javier Martinez-Picado and Julia G. Prado: The CoRP Study Grou.  Highly Pathogenic Adapted HIV-1 Strains Limit Host Immunity and 3 Dictate Rapid Disease Progression. AIDS. June 1: 2014 Read

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