Man achieves long-term HIV remission without bone marrow transplant
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Researchers reported the first case of long-term HIV remission without the need for a bone marrow transplant.
The patient, a 34-year-old Brazilian man who was diagnosed with HIV in 2012, was one of five individuals in a clinical trial who received a specialized treatment regimen that included maraviroc and nicotinamide. He has tested negative for over a year.
The case was presented Tuesday by Ricardo Diaz, MD, of the University of São Paulo, during the AIDS 2020 conference. It followed the revelation last year of the second person — the so-called “London patient” — to achieve sustained HIV remission after a stem cell transplant, a risky and expensive procedure.
Diaz and colleagues noted that the Brazilian patient’s apparent remission was an “isolated case” that requires further analysis.
"We need more data from more individuals than one and we need to know how long he was infected and we need to watch him for longer,” said conference co-chair Monica Gandhi, MD, MPH, professor of medicine at the University of California, San Francisco, who was not involved in the study.
According to Diaz and colleagues, the man had a baseline CD4+ count of 372 cells/µL and viral load of 20,221 cp/mL, which suggested chronic HIV infection. He began ART with tenofovir disoproxil fumarate/lamivudine/efavirenz in December 2012 and maintained a viral load below detectable limits.
In 2016, the patient joined a clinical trial and began receiving “highly intensified” ART — his baseline ART plus dolutegravir and maraviroc, as well as nicotinamide 500 mg twice a day for 48 weeks.
“We knew that maraviroc was a latent reversal agent, and we knew that nicotinamide has that property of being a latent reversal agent besides boosting the immune system,” Diaz said during the press event.
According to the researchers, among 30 patients included in the study, he was the only one who experienced viral load “blips” during the experimental treatment.
The researchers reported that 57 weeks after structured treatment interruption, the HIV DNA in cells and his HIV antibody test remained negative.
Diaz said the man has tested negative for more than 64 weeks.
“They’ve all been undetectable viral loads,” he said.
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Diaz R. The first long-term remission of a chronic HIV-1 infection without myeloablation? Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
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