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French study offers hope in quest for Aids cure

A small French study of 14 HIV patients who have remained healthy for years after stopping drug treatment offers fresh evidence that early medical intervention may lead to a "functional cure" for AIDS, researchers said this week.

French study offers hope in quest for Aids cure

The research, published in the US journal PLoS Pathogens, comes on the heels of a report last week that a baby in Mississippi appeared to be cured of HIV after aggressive antiretroviral drug treatment delivered within 30 hours of birth.

Experts agree that while parallels between the two studies are intriguing, the phenomenon is rare – and warn that most of the 34 million people infected with HIV worldwide would develop full-blown AIDS if they stopped taking drugs to repress the human immunodeficiency virus.

Myron Cohen, a well-known US expert on HIV and chief of the Center for Infectious Diseases at the University of North Carolina, described the French study as "provocative".

"It provokes us to think. Who in the universe of people treated early can come off treatment? They showed us some clues, but it is a question that demands more science," he told AFP.

The study involves 14 adults, a group known as the VISCONTI cohort, which stands for Viro-Immunologic Sustained Control After Treatment Interruption.

They were treated for HIV with a range of antiretroviral drugs, each within 10 weeks of infection, and stopped treatment around three years afterward on average.

The group has been able to keep viral loads under control for a median of 7.5 years without drug treatment, said the study.

The individuals do not have the genetic characteristics of another rare group of people – fewer than one percent of the population – who appear able to spontaneously stave off HIV without medicine and are known as "natural" or "elite controllers".

Those in the VISCONTI group, described as "post-treatment controllers," have not completely eliminated HIV from their bodies. They continue to maintain it at a low level in their cells and have not become sick.

Researchers cautioned, though, that the mechanism that explains why these patients can fight HIV without drugs remains unclear. Several immunologic tests have not found a singular cause for their continued control of the virus.

"These individuals reflect what a functional cure may represent because they have been actually controlling the infection for many years now," said lead researcher Asier Saez-Cirion of the Institut Pasteur in Paris.

"I think this is proof of concept that this may be achieved in individuals," he said in a phone interview with AFP. "And that this happened thanks to early treatment onset".

All of those in the study live in France and currently range in age from 34 to 66. They were infected with HIV in the 1990s and 2000s.

Since they were handpicked for the study after they appeared to be able to control HIV upon stopping treatment, it is unclear what percentage of the population they may represent.

Preliminary research on them was presented at the International AIDS Conference in Washington last year. Scientists are continuing to study the group for clues about how and why their bodies act the way they do.

After an acute infection, HIV establishes viral reservoirs in cells that allow it to hide and return, even after prolonged treatment, meaning that most patients who stop taking medication see the infection return.

"These reservoirs are what stand between us and a cure for HIV," said Rowena Johnston, amfAR (The Foundation for AIDS Research) vice president for research.

"The control of HIV infection even after therapy is stopped is an interesting phenomenon that hints at what antiretroviral therapy might be able to achieve over and above its use as ongoing treatment," she told AFP.

According to Christine Rouzioux, who is part of the French research team, the early treatment "may have limited the establishment of viral reservoirs" and helped to preserve the patients' immune responses.

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Paris has one of highest rates of psychosis, new study finds

Paris and southeast London have the highest rate of people reporting psychotic episodes, according to a new international study that compared rates of the mental disorder in six countries.

Paris has one of highest rates of psychosis, new study finds
Photo: AFP

A total of 17 areas in Britain, France, Italy, The Netherlands, Spain and Brazil were covered in the report in the Journal of the American Medical

Association (JAMA) Psychiatry.

Researchers described the study as the largest international comparison of psychotic disorders to date, and the first major analysis of its kind in more than 25 years.

A previous study in 1992 that spanned eight diverse settings in rural and urban India, Japan, Europe and North America found that the rates of
schizophrenic disorders were “surprisingly similar.”

But the latest study found that rates of psychosis can be close to eight times higher in some regions compared to others, with the lowest incidence seen in the area around Santiago, Spain, and the highest in inner-city Paris and Southeast London.

“It's well-established that psychotic disorders, such as schizophrenia, are highly heritable, but genetics don't tell the whole story,” said lead author James Kirkbride, professor of psychiatry at University College London.

“Our findings suggest that environmental factors can also play a big role.”

The study was based on people aged 18-64 who contacted mental health services after a suspected first psychotic episode.

A total of 2,774 cases were analyzed.

Population density was not a factor in the psychotic rate, nor could differences be explained by age, sex or ethnic composition.

Rather, researchers found higher rates in younger men, among racial and ethnic minorities, and that “the strongest area-level predictor of high rates of psychotic disorders was a low rate of owner-occupied housing,” said the report.

The findings suggest “social deprivation” may be at play, said co-author Hannah Jongsma, a researcher at the University of Cambridge.

“People in areas that are socially deprived may have more social stresses, which could predict psychosis incidence, as suggested by other studies,” Jongsma said.

“An alternative explanation could be that owner-occupied housing is an indicator of social stability and cohesiveness, relating to stronger support networks.”

According to an accompanying editorial in JAMA, the study, like the 1992 one before it, “raises more questions than it answers.”

“We hope that it will spur further international efforts to explore how variation in sociocultural environments might be associated with psychosis incidence.”