HIV drugs may help prevent multiple sclerosis, a major new study suggests

Over the past decade, several case studies have reported that people with multiple sclerosis (MS) who started antiretroviral therapy for HIV (to keep the virus in check) later found that their MS symptoms either disappeared completely or that the course of the disease slowed significantly.

These findings forced researchers to ask whether HIV or antiretroviral drugs might affect the risk of developing MS. According to our latest studypublished in the Annals of Neurology, the answer is yes.

It is very difficult to be sure whether HIV or antiretroviral drugs can affect MS because large groups of people living with HIV, with detailed medical information about both HIV and MS, need to be followed over a long period.

Three studies previously asked this question but had either too few patients or no access to information on antiretroviral treatment. Consequently, previous studies have not provided definitive answers.

For this study, we used large population-based health databases and clinical HIV and MS registries. They included virtually every person in British Columbia, Canada and Sweden who was medically recognized as HIV positive dating back to 1992 in Canada and 2001 in Sweden.

We followed people with HIV from the first date their HIV infection was detected until the end of the study period (2020 in Canada and 2018 in Sweden). New MS diagnoses during this period were searched using hospital and physician data, as well as information from specialist MS clinics.

The rate of new MS cases among people with HIV was compared to the rate of new cases in the general population within each region to determine whether there was indeed a different risk of MS in people with HIV.

We identified over 29,000 people with HIV and followed them for an average of almost ten years. During this period, only 14 HIV-positive people developed MS, which was 47% fewer cases than expected based on the number in the general population.

When we looked specifically at people who had taken antiretroviral drugs (almost everyone in the study), and only after they started antiretroviral treatment, we found 45% fewer MS cases than expected. In other words, we found a reduced risk among people who were HIV positive and had used antiretroviral therapy.

The risk of MS was most significantly reduced for women, with a reduction of 72%. There were also fewer men who developed MS in the HIV population than expected, but the difference in risk was less pronounced in men than in women.

Possible biological explanation

From the results of this study alone, it is not possible to determine whether the virus or the antiretroviral treatment may be responsible for the reduction in MS risk. However, there are biological reasons that support both theories.

HIV leads to a progressive loss of immune cells called CD4+ T cells. These same cells are implicated in MS, as they initiate the cascade of events that lead to inflammation in the brain and spinal cord. By reducing the number of CD4+ T cells, infection with HIV can reduce the likelihood that a person will develop MS.

However, the finding that MS risk was lower when the HIV virus is supposedly suppressed by antiretroviral drugs may give some hope that it is the treatment rather than the virus that plays a role.

Possible mechanisms for the effectiveness of antiretroviral agents in reducing MS risk and disability include inhibition of the Epstein-Barr virus. More and more research is accumulating to shed light on this important role of Epstein-Barr in MS.

The antiviral properties of HIV therapy can limit the activity of the Epstein-Barr virus, thereby minimizing both the risk of developing MS and the progression of the disease in those who have it.

The discovery that HIV infection or antiretroviral drugs provide a protective effect against MS has the potential to broaden our understanding of the causes of MS and how the disease damages the body.

Although treatments are available for the relapsing form of MS, none can stop the persistent progression seen later in the disease. Results from this study may encourage a more concerted effort to determine whether antiretroviral drugs can slow MS disease progression.

With limited research resources, this approach could provide a more immediate benefit, addressing the large unmet need to develop better treatments aimed at preventing or slowing the progression of MS.

Author: Kyla McKay - assistant professor of neuropediology, Karolinska Institutet | Elaine Kingwell - Senior Researcher, Primary Care and Population Health, UCL The conversation


https://nord.news/2023/12/20/hiv-drugs-may-help-prevent-multiple-sclerosis-a-major-new-study-suggests/?feed_id=60843

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