HIV Remission: Improving Clinical Communication Towards an HIV Cure

By Joseph Tucker, MD, PhD

HIV cure research has progressed substantially in the past five years, raising an important clinical question. How should physicians define HIV cure within clinical contexts? More specifically, HIV-infected individuals will gradually bring questions about what HIV cure means for them into the clinic, in advance of the development of a widespread HIV cure. A number of concepts that can be used to communicate about HIV cure have been proposed, including functional cure, sterilizing cure, sustained virological response, and remission. Although not without flaws, the concept of HIV remission is the most accurate to use in clinical contexts (more detailed opinion piece here).

Remission refers to reducing the symptoms associated with a disease. While it clearly denotes an improvement compared to the active disease state, there is uncertainty embedded in the concept indicating that the patient requires close follow-up and attention. Cancer patients in remission return to their doctor for periodic testing just as HIV remission patients in the future would need to do to assess for return of HIV infection. The remission concept has been around for centuries and would have immediate recognition among a broad cross-section of HIV-infected individuals. Despite widespread understanding, the HIV remission concept has some flaws. HIV-infected individuals from low-income nations with limited cancer care may be less familiar with the concept of remission. However, the remission concept is used in other clinical contexts in low-income countries. For example, malaria remission is noted and may make the concept more broadly recognizable in these contexts.

Our language around HIV cure must reflect today’s clinical reality. While we have the aspiration to definitively cure HIV (as we should), the clinical reality is a less definitive middle ground. What happens after someone receives an intervention to cure HIV is not known. Our language must reflect this uncertainty, and as such, remission is the most appropriate concept to use in discussing HIV “cure” in a clinical context.