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Author Topic: Man Who Began HIV Treatment 5 Days In Appears Virus-Free  (Read 1605 times)

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Offline Cosmicdancer

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Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« on: March 25, 2014, 06:07:11 PM »
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 infection—an 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 man’s 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 man’s 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
Summer, 2007 - &$#@?
November, 2007 - Tested poz, 300,000 vl, 560 cd4
Feb, 2008 - 57,000 vl, 520 cd4, started Atripla
June, 2008 - undetectable, 612 cd4
January, 2009 - undetectable, 670 cd4
May, 2009 - undetectable, 593 cd4
Sept, 2009 - 83 vl, 763 cd4, 34%
Dec, 2009 - undetectable, 889 cd4, 32%
April, 2010 - undetectable, 860 cd4, 31%
October, 2010 - undetectable, 800 cd4, 38%
April, 2011 - undetectable, t-cell test not done
October, 2011 - undetectable
April, 2012 - undetectable, 850 cd4, 39%
November, 2012 - undetectable, 901 cd4, 41%
April, 2013 - undetectable, 846 cd4, 36%
October, 2013 - undetectable
May, 2014 - undetectable, 784 cd4, 48%
October, 2014 - UD, 1084 cd4, 48%

Offline AusShep

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Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #1 on: March 25, 2014, 06:22:33 PM »
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.

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #2 on: March 26, 2014, 08:21:50 AM »
They're only guestimating he had been infected five days previous - so it may have been less.


The older risk based protocols had 2 drug PEP treatments.


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.

Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline mecch

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Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #3 on: March 26, 2014, 08:55:41 AM »
Lucky guy.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline AusShep

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Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #4 on: March 26, 2014, 11:31:33 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.

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. 

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #5 on: March 26, 2014, 12:14:15 PM »
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. 

You're not joking. I hesitated to even post that thought here because of all the WWs who read these threads.
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline mdh26

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Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #6 on: March 27, 2014, 05:50:04 PM »
eh. I started treatment two weeks post infection, went UD quickly, and didn't test positive on the AB test for over a year after infection. I don't know how exactly they're looking for the virus, but if it's the normal tests we take then it's likely the same has happened to him.

Offline Mishma

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Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #7 on: March 28, 2014, 01:48:08 AM »
Certainly supports PrEP and hitting a Pt quickly and hard-without resorting to genotyping. Heck, I was never genotyped. By the time the test became available I was already back to VL<20, so no material to work with.

Primary antibody responses occur after two weeks and peek before 4 weeks. Secondary reponses are seen approximately 8-10 weeks post infection, so I'd be curious to see if the researches followed up with these time frames.

I wish him all the luck in the world. In the immortal words of Red Green, "We're pulling for you." "We're all in this together."
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline dico

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Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #8 on: March 28, 2014, 04:41:19 AM »
eh. I started treatment two weeks post infection, went UD quickly, and didn't test positive on the AB test for over a year after infection. I don't know how exactly they're looking for the virus, but if it's the normal tests we take then it's likely the same has happened to him.

Could you tell us more about your story ? You were on treatment for one year but even with that you did test positive after one year ?
And how did you know you were infected to start ART ?

Offline xinyuan

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Re: Man Who Began HIV Treatment 5 Days In Appears Virus-Free
« Reply #9 on: March 30, 2014, 09:39:47 AM »
Could you tell us more about your story ? You were on treatment for one year but even with that you did test positive after one year ?
And how did you know you were infected to start ART ?

From what I gathered going through prior posts, the person never tested antibody positive.

Initial HIV tests depend on the human body making antibodies. Antibodies that these tests detect. ELISA and Western Blot depend on these.

I could imagine a scenario where a person never makes the right antibodies. Ones that never react. Like the complete opposite of broad spectrum "super" antibodies in some controllers.

The true gold standard test is picking up HIV RNA in the body. This is done every time we get viral loads (VL) tested.



If you have a VL >10-15,000, you most certainly have the virus. At 950,000 in mdh26, there is no doubt.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/HIV-care/



Keep in mind that all of these test for HIV-1, which is far more common in the world than HIV-2. Unless you're in Africa.

 


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