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Man Who Began HIV Treatment 5 Days In Appears Virus-Free

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Cosmicdancer:
This is in the Treatment News section of Poz, but I thought I'd share it here.  This case was reported at CROI.  I'm surprised it wasn't mentioned earlier.

Man Who Began HIV Treatment 5 Days In Appears Virus-Free

A man who contracted HIV perhaps five days before starting a pre-exposure prophylaxis (PrEP) regimen and who then received full antiretroviral (ARV) treatment an estimated 12 days after infection shows no sign of the virus several months later. The man was enrolled in The PrEP Demo Project, a program targeting high-risk men who have sex with men. Information from this case study was presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

The man tested negative through pooled RNA, 4th generation enzyme-linked immunosorbent (EIA) assay, and rapid antibody tests from samples drawn 21 and 13 days before he began taking Truvada (tenofovir/emtricitabine) as PrEP. The sample drawn the day he started PrEP showed that his RNA level was 220 copies, while the other two HIV tests conducted on that sample were negative, indicating a very early infectionóan estimated five days old.

He took PrEP for seven days. Taking just two HIV medications, as are included in PrEP, instead of the standard three is against treatment protocol if someone is found to have HIV. But it took time for his RNA screen test to come back, so the investigators did not know he had an acute HIV infection during his first week on PrEP. 

Once his HIV infection was discovered, he was put on a conventional HIV treatment cocktail of Prezista (darunavir), Norvir (ritonavir) and Truvada.

The manís HIV RNA levels dropped from the initial 220 to a read of 120 a week after he started PrEP, and then to below 40 about 27 days after infection. Since then, researchers have been unable to detect HIV in his body, using highly sensitive tests.

Researchers intend to try taking him off ARVs after a year.

The scientists are not able to conclude at this time how PrEP may have contributed to the apparent dissipation of the virus in the manís body. They advise that programs prescribing PrEP should consider testing for acute HIV both before and during the use of PrEP and then to consider immediately switching to a full HIV treatment regimen in the event of HIV infection.


http://www.poz.com/articles/virus_free_761_25339.shtml

AusShep:
So basically they think PEP may have been effective up to 5 days after exposure instead of the recommended 72 hours?

The older risk based protocols had 2 drug PEP treatments.

Ann:
They're only guestimating he had been infected five days previous - so it may have been less.


--- Quote from: AusShep on March 25, 2014, 06:22:33 PM ---
The older risk based protocols had 2 drug PEP treatments.


--- End quote ---

Truvada alone is still a valid PEP combo and is often used when the risk is on the lower side (ie neg top, known untreated-poz bottom).

I'm kinda scratching my head here as to why this is news - after all, the 72 hour cut-off for PEP is really just a best-guess scenario in itself as to when it would be too late to bother.

As long as PEP is started before hiv gets a chance to infiltrate the reservoirs, it should work, and just like anything else hiv-related, so much depends on the individual. It could infiltrate one person's reservoirs quicker - or slower - than another person.

Something else to consider - people who are given PEP aren't normally screened with RNA testing during their treatment. The ONLY reason this guy was screened with RNA is because he was in a PrEP study. You could very possibly have these types of low-level results quite often in PEP patients during the first week or so - when they have actually been infected and are not taking PEP for a no risk situation.

mecch:
Lucky guy.

AusShep:

--- Quote from: Ann on March 26, 2014, 08:21:50 AM ---...
Something else to consider - people who are given PEP aren't normally screened with RNA testing during their treatment. The ONLY reason this guy was screened with RNA is because he was in a PrEP study. You could very possibly have these types of low-level results quite often in PEP patients during the first week or so - when they have actually been infected and are not taking PEP for a no risk situation.

--- End quote ---

That's a good point.  I think it would freak most people out even more telling them they don't have antibodies, but their VL is 40, so they're infected and hopefully PEP will take care of it. 

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