Prolonged absence of HIV viral load rebound reported in Brazilian individual after ART interruption, but the factors involved are unclear.
Contact: Richard Jefferys: richard.jefferys@treatmentactiongroup.org
New York City, July 8, 2020 – Yesterday, a widely reported presentation by Ricardo Diaz at the ongoing virtual International AIDS Conference (AIDS2020) disclosed that one out of 30 total participants in an HIV cure-related research trial conducted in Brazil has not experienced an HIV viral load rebound for a little over a year (64.7 weeks) after interrupting antiretroviral therapy (ART). Whether the interventions received during the trial contributed to the outcome is extremely uncertain because there have been prior reports of rare individuals who’ve interrupted ART without experiencing a return of HIV viral load for variable periods (referred to as HIV remission).
A number of mainstream news stories have erroneously reported that the individual was a participant in a five-person trial in which a standard ART regimen was supplemented with the integrase inhibitor dolutegravir, the CCR5 inhibitor maraviroc, and nicotinamide (a water-soluble form of vitamin B3) for 48 weeks. In fact, this five-person group represented one arm of a trial that recruited 30 participants who were divided into six groups of five, with one group receiving standard ART (to serve as a control) and the other five groups receiving different combinations of interventions.
Of the other participants in the trial, nine received nicotinamide, and 14 received dolutegravir and maraviroc. No other participants experienced a prolonged lack of viral load rebound after ART interruption, which raises questions about the contribution of the interventions to the outcome in the participant currently experiencing HIV remission. Furthermore, HIV DNA (a surrogate measure of the HIV reservoir) was still detectable in this individual’s blood samples at the end of the 48-week intervention period in September 2016, with HIV DNA levels continuing to decline afterward during treatment with standard ART regimens until the ART interruption in March 2019. Given that the trial interventions were no longer being administered, it’s unclear if they played any role in this continuing decline in HIV DNA levels.
The take-home message is that further details will be needed to learn more about the factors involved in this potentially encouraging case of HIV remission. The limited available evidence does not support adding dolutegravir, maraviroc and nicotinamide to ART regimens in hopes of achieving similar outcomes. According to a report from the Associated Press, Ricardo Diaz is receiving funding to conduct a larger 60-person trial, so more robust data on the effects of the interventions is likely to be forthcoming.[1]
# # #
About TAG: Treatment Action Group (TAG) is an independent, activist and community-based research and policy think tank fighting for better treatment, prevention, a vaccine, and a cure for HIV, tuberculosis, and hepatitis C virus. TAG works to ensure that all people with HIV, TB, and HCV receive lifesaving treatment, care, and information. We are science-based treatment activists working to expand and accelerate vital research and effective community engagement with research and policy institutions.
[1] Marchione M. Doctors say experimental treatment may have rid man of HIV. The Associated Press. 2020 July 7. https://apnews.com/32171d5b5edb3babe25ba6edc4b505d6