Interruption of treatment: what conditions?

The HIV remission (HIV cure) research effort has intensified in recent years and the number of Cure trials is increasing. A certain number of these researches involve Analytical Interruptions of Treatment (IAT): the participant in this type of research, who is living with HIV, stops – for a time and under control – taking their antiretroviral treatment . People who have an IAT have frequent blood tests to check for any signs of viral rebound. Indeed, this viral rebound could expose their HIV-negative partners — in the absence of other means of protection — to the risk of contracting HIV. Little research has been conducted on the opinions of participants in these trials and their partners. Professor Karine Dubé of the University of California at San Diego (United States) is interested in this subject. His current research focuses on integrating socio-behavioural research into HIV remission trials in the United States and South Africa. In a study presented on the website aidsmap, Prof. Dubé and her colleagues explored the perceptions of people living with HIV (PLHIV) and their sexual partners on the impact of TAI. A total of ten serodiscordant couples participated in this study. Most were same-sex male couples, but two heterosexual couples were also included. Participants were asked about factors that might influence their decision to participate, or not, in research on remission. As expected, the impact on participants’ health was widely discussed by PLHIV and their HIV-negative partners. Assurance that HIV-negative partners would enjoy some degree of protection was an essential condition of engagement. Some people pointed out that Prep should be available as part of the trial. In addition, for many interviewees, it was important to receive adequate compensation in exchange for the time spent participating in the study. In addition, people described how they needed reassurance that they would have the appropriate resources to deal with any illnesses resulting from their participation in the trial. Another important point, an IAT would probably lead to a viral rebound and therefore a loss of the “undetectable = untransmissible” status in PLHIV. The stigmatization of people with a detectable viral load, particularly in gay sex spaces, has been highlighted by HIV-positive people and their partners. “I think we haven’t done a very good job in recent years of destigmatizing people living with HIV who have a detectable viral load. So I really think, including for me, that voluntarily moving towards a detectable viral load again could revive some of this internalized stigmatization” declared one of the participants. In summary, Dr. Dubé and her team shed light on the views of potential participants in research on curative treatments and, for the first time, of their partners. From these interviews emerged concerns about scientific rigor, the desire for appropriate financial compensation, and assurances that health will be protected. The fear of being stigmatized again because of a detectable viral load is also a crucial point to take into account in the inclusion and support of PLHIV who stop their treatment within the framework of an IAT.