First person with HIV in long-term remission without stem cell transplant

A Brazilian man shows no evidence of HIV remaining in his body after over a year off HIV antiretrovirals, but researchers say it's too early to speak of a functional cure.

The 35-year-old man from Sao Paulo was part of a clinical trial called SPARC-7 which hoped to evaluate different methods for reducing and controlling HIV reservoirs within the body. The man in question was diagnosed in October 2012 with a CD4 count of 372 copies/mm3 and a viral load of over 20,000 copies/ml. He was started on treatment two months later on efavirenz (EFV), zidovudine (AZT) and lamivudine (3TC) – although tenofovir disoproxil fumarate (TDF) later replaced the AZT.

HIV reservoirs are a collection on inactive HIV viruses hidden away within cells that antiretrovirals cannot reach. Whilst this is not considered much of problem for people on regular treatment if that treatment is stopped the reservoirs will reactive and start reproducing copies of the virus.

SPARC-7 study recruited HIV positive adults who were still on their first HIV antiretroviral combination and who’s CD4 had never dipped below 350 copies/mm3.

The man whose case was presented at AIDS 2020 this week had two antiretrovirals, dolutegravir (DTG) and maraviroc (MVC) added to his existing three-drug regimen, alongside nicotinamide (water soluble vitamin B3).

After 48 weeks on the combination on EFV, TDF, 3TC, DTG, MVC and nicotinamide he returned to his three-drug regimen, later replacing EFV for nevirapine (NVP).

In March 2019, all treatment was interrupted with close monitoring. At the time of writing, 15 months later, he continues to have both undetectable HIV RNA and DNA.

Experts have cautioned people not to read too much into this one man’s case and highlighted that past promising cases, such as the Mississippi Baby, have ended in disappointment.

Further testing, including biopsy of the man’s gut tissue and lymph nodes, will need to be carried out to ascertain whether this is indeed a functional cure, but these have been put on hold whilst COVID-19 dominates the healthcare system.

Four other individuals in SPARC-7 on the same treatment protocol did not active long-term remission.