HIV controllers: to treat or not to treat? Is that the right question?

Noël, Nicolas; Sáez‐Cirión, Asier; Avettand-Fènoël, Véronique; Boufassa, Faroudy; Lambotte, Olivier

doi:10.1016/s2352-3018(19)30264-4

Cited by 17 publications

(21 citation statements)

References 59 publications

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“…There are some patients who are HIV controllers [26]. Even Though It is not known if those patients considered tolerant to HIV are, in fact, cases produced by the primary exposure to a minimum minimorum inoculum, which would be consistent with our working hypothesis.…”

Section: Journal Of Emerging Diseases and Virologysupporting

confidence: 76%

Bayesian Model for Covid-19 to Achieve Immunity by Parsimony of Exponential Functions Minimizing the Inoculum

Lamothe¹,

Lamothe²,

Lamothe³

et al. 2021

J Emerg Dis Viro

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A ribonucleoside analog MK-4482/EIDD-2801 blocks SARS-CoV-2 transmission in ferrets and might be able to diminish transmission until vaccineinduced or naturally acquired protective herd immunity is reached [1]. As skinner pointed out, behavioral problems have to be solved through behavioral engineering [2]. Cybernetics has full application in the present condition. As in alcohol consumption, smoking, drugs, gun crimes, wars, and sexually acquired diseases, the teleological Aristotelian causes are not tobacco, drugs, and any other issue, but the aberrant behavior. The situation is not trivial and involves non-classic logic and other mathematical logics [3,4]. The neural topography corresponds to the nucleus accumbens. The latter is the battlefield, and the subject’s obsession is the rise of the neurotransmitter dopamine [3,4]. In general, people are very demanding from their governments; nevertheless, at the same time, they are deeply tolerant with their aberrant behavior promoting the dissemination of the SARSCoV-2 [4,5]. This paper examines how to deal with this problem from a scientific perspective, considering probability methods and classical and doxastic logic, using the Parsimony Principle aiming to reach immunity by minimizing the inoculum.

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Section: Journal Of Emerging Diseases and Virologysupporting

confidence: 76%

Bayesian Model for Covid-19 to Achieve Immunity by Parsimony of Exponential Functions Minimizing the Inoculum

Lamothe¹,

Lamothe²,

Lamothe³

et al. 2021

J Emerg Dis Viro

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“…Despite HIV suppression in the absence of ART in this subgroup, studies have demonstrated increased inflammation, particularly T cell activation in elite controllers, in addition to worse surrogate measures of CVD compared to PLWH on ART (27)(28)(29)(30). However, the limited clinical data available is conflicting regarding the CVD risk in this small subgroup with potential confounders such as Hepatitis C virus co-infection and limited access to healthcare suggested as other possible explanations for these initial observations (31)(32)(33). Further…”

Section: Overall Benefit Of Art and Viral Suppression On Reducing Cvd Riskmentioning

confidence: 86%

Cardiovascular disease in HIV patients: recent advances in predicting and managing risk

McGettrick

Mallon

Sabin

2020

Expert Review of Anti-infective Therapy

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Introduction: Cardiovascular disease (CVD) is one of the leading causes of mortality in virally suppressed people living with HIV (PLWH) and with an ageing population, is likely to become one of the leading challenges in maintaining good health outcomes in HIV infection. However, factors driving risk of CVD in PLWH are multiple and may be different from those of the general population, raising challenges to predicting and managing CVD risk in this population.Areas covered: In this review, we examine the relevant data regarding CVD in HIV infection including that on CVD prevalence, pathogenesis and contributing factors. We review the data regarding CVD risk prediction in PLWH and summarise factors, both general and HIV specific, that may influence CVD risk in this population. And finally we discuss appropriate management of CVD risk in PLWH and explore potential therapeutic pathways which may mitigate CVD risk in the future in this population.Expert opinion: Following a comprehensive review of CVD risk in PLWH, we give our opinion on the primary issues in risk prediction and management of CVD in HIV infected individuals and discuss the future direction of CVD management in this population.

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“…Whether HIV controllers with such a low risk profile should be considered as a group deserving specific guidelines for starting ART is a debatable issue. [ 26 , 27 ]…”

Section: Discussionmentioning

confidence: 99%

Elite and viremic HIV-1 controllers in West Africa

N’Takpé

Gabillard

Moh

et al. 2021

Aids

Self Cite

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Background: Data on HIV-1 controllers in Africa are scarce. We report the proportion of HIV-1 controllers in a group of adults prospectively monitored with frequent viral load measurements as part of a clinical trial in West Africa. Methods: For the Temprano trial, antiretroviral therapy (ART)-naive HIV-1 infected adults with no criteria for starting ART were randomized to start ART immediately or defer ART until the WHO starting criteria were met. Plasma viral load was measured every 6 months. The trial follow-up was 30 months. We considered all Temprano participants randomized to defer ART. Patients with all semestrial viral <2000 copies/ml and still off ART at month 30 were defined as HIV-1 controllers. Controllers with all viral loads <50 copies/ml were defined as elite controllers, the rest as viremic controllers. Results: Of the 1023 HIV-1-infected adults randomized in the Temprano deferred-ART group, 18 (1.8%) met the criteria for classification as HIV controllers, of whom seven (0.7%) were elite controllers and 11 (1.1%) viremic controllers. The HIV-1 controllers had low peripheral blood mononuclear cell HIV-1 DNA and low inflammatory marker levels. They maintained high CD4 + cell count and percentages and had a low morbidity rate. Discussion: HIV controllers exist in Africa at a proportion close to that reported elsewhere. They represent a small fraction of all HIV-1-infected patients but raise important questions. Further studies should assess whether starting ART might represent more risk than benefit for some controllers, and where it does, how to identify these patients before they start ART.

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HIV controllers: to treat or not to treat? Is that the right question?

Cited by 17 publications

References 59 publications

Bayesian Model for Covid-19 to Achieve Immunity by Parsimony of Exponential Functions Minimizing the Inoculum

Bayesian Model for Covid-19 to Achieve Immunity by Parsimony of Exponential Functions Minimizing the Inoculum

Cardiovascular disease in HIV patients: recent advances in predicting and managing risk

Elite and viremic HIV-1 controllers in West Africa

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