AIDS 2020 – Brazilian man achieves HIV remission


  • Pavankumar Kamat
  • Conference Reports
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Takeaway

  • A Brazilian man treated with an intensified antiretroviral regimen plus supplemental vitamin B3 for 48 weeks in a trial has experienced a period of remission from HIV in the absence of effective treatment for more than a year.

Why this matters

  • Previously, a Mississippi baby, a San Francisco man, a 24-year-old Thai man, a 9-year-old South African child, and the London and Berlin patients have achieved HIV remission.

Key highlights

  • The man was being treated for HIV since his diagnosis in 2012.
  • His regimen comprised a combination of efavirenz, lamivudine, and tenofovir disoproxil fumarate.
  • He enrolled in a study in 2016 and was 1 of 5 individuals randomly assigned to receive dolutegravir, maraviroc and twice-daily nicotinamide 500 mg in addition to his regular regimen for 48 weeks.
  • Low levels of viral DNA were seen in peripheral blood spots and rectal tissue at baseline and 48 weeks.
  • HIV antibodies reduced from 91.8 RLU at baseline to 58.0 RLU at week 48.
  • After 48 weeks, the patient resumed his usual regimen for 3 years.
  • In March 2019, he agreed for an analytical treatment interruption and discontinued all HIV treatments.
  • For the next 64.7 weeks, his viral load remained undetectable when assessed every 3 weeks and so did HIV DNA in blood spots. 
  • In February 2020, his HIV antibody test results were negative.

Commentary
Carl Dieffenbach, PhD, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, said: "But as with the Berlin and London patients, it seems unlikely that — even if the man remains HIV-free into the future — the circumstances of his remission will be broadly applicable to other people with HIV."