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Very Early HIV Treatment Leads to Another New Case of a Functional Cure

By Warren Tong

July 3, 2013

More HIV cure news comes to us in the form of a German man -- not the "Berlin patient" -- who is reportedly showing no HIV in his blood after starting treatment early and then discontinuing for nine years, according to a poster presented at IAS 2013.

In the poster, German researchers report a unique case study of a 67-year-old man who was diagnosed with HIV in 1999. Tests at the time suggested that he had just seroconverted in the last month. His viral load was over 100,000 and his CD4+ cell count was below 500.

He was immediately started on a treatment regimen of zidovudine/lamivudine (Combivir) and efavirenz (Sustiva, Stocrin) and achieved an undetectable viral load shortly after. His CD4+ cell count rebounded to around 1,000.

After five and a half years of antiretroviral therapy, the patient decided to try a treatment interruption, with guidance from Jan van Lunzen, M.D., his treating physician and the study's lead author. Immediately afterward, he experienced a slight increase in viral load, but it quickly dropped back to undetectable within three months of stopping treatment.

The researchers continued to follow him for nine years and were unable to detect any HIV in his peripheral blood mononuclear cells using ultrasensitive viral load tests that detect viral loads as low as 1. Throughout, his CD4+ cell count has remained stable between 800 and 1,000.

The patient showed immune responses and lab numbers similar to those seen in elite controllers. To make sure he was not an elite controller himself, the researchers tested for a telltale mutation of the CCR5 receptor on his CD4+ cells and found none.

However, using a humanized mouse model, whereby the investigators transplanted purified donor CD4+ T cells and anti-CD3/CD28 stimulation, they were able to recover some HIV, indicating the presence of replication-competent virus and suggesting that it remains too early to consider the patient entirely cured of his HIV infection.

"The data obtained in this unique case suggest a functional cure of this patient rather than viral eradication after early onset cART (combination antiretroviral therapy)," the study authors wrote.

"The presence of strong HIV-specific T-cell responses, normal frequency of regulatory T cells and animal data suggest a strong role of preserved adaptive immune responses as a correlate of viral control in this patient. Subsequent virological and immunological studies should look into the correlate of viral control in this and other PTC patients," they concluded.

"I think all patients with early PHI (primary HIV infection) should be offered treatment. This will increase the likelihood to become a post-treatment controller," van Lunzen told TheBodyPRO.com.

Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.

Follow Warren on Twitter: @WarrenAtTheBody.


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