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  • 1.  Stop HIV treatment in Elite control

    Posted 09-06-2021 23:47

    Have a 30y male patient started on immediate treatment a year ago before labs where available; Viral load came with an 80 copies report and CD4 650 cells but he was already on ART and doing well so they continued ART.
     He has been sent to my office for evaluation next week.

    If  he had been undetectable (he was 80 copies) in the beginning, would you try stoping the treatment trying to find if he is really an Elite? Or rather continue ART  already started? William Lenis 

    William Lenis
    Fundacion Valle del Lili

  • 2.  RE: Stop HIV treatment in Elite control

    Posted 09-07-2021 16:43
    Earlier in the epidemic, even just 5 years ago, many patients were still not on therapy as it was not widely accepted to start treatment on all patients. During that time and before, long term follow up on those patients were available, and of them, very few were elite controllers. In our office of 2200 HIV patients we have a total of 10. Since the idea of starting therapy at any CD4 count, AND the idea of treatment as prevention, it is hard to say if I would ever do a trial of discontinuing medication to see if someone is an elite controller. A few worries I have: stopping medications to see would mean if this person was NOT an elite controller and they were in a serodiscordant relationship, the possibility of this person transmitting virus to their partner. I think there is also other implications to stopping medication on someone that has been told medication is important for their own health and others, that if he does discontinue, feel well, and even develops a low viral load but good CD4, they might not return to medication thinking its not that important. I think its an interesting thought and I would probably be very careful doing it, and having a lot of couselling and conversation before to discuss risks and benefits.

    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA

  • 3.  RE: Stop HIV treatment in Elite control

    Posted 09-08-2021 15:19
    The DHHS guidelines document has a nice discussion of this question in the When to Start section, and they generally come down in favor of treating elite controllers. As long as the diagnosis of HIV is clear, there would be no reason to stop ART.

    Joel Gallant, MD, MPH
    San Francisco, CA