Man With HIV Is in Long-Term Viral Remission After Intensified Treatment

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Ptrk3:
From the July 7, 2020, edition of (online) POZ magazine:

Lede:

A Brazilian man diagnosed with HIV in 2012 has maintained a fully suppressed viral load for over a year after receiving a yearlong intensified treatment regimen and then discontinuing his antiretrovirals (ARVs). Researchers have indicated that if sufficient time passes without the man’s viral load rebounding, he could become the first person officially cured of HIV without receiving a bone marrow transplant.

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Link to story:

https://www.poz.com/article/man-hiv-longterm-viral-remission-intensified-treatment

Ptrk3:
The Associated Press has picked up the story (published July 7, 2020). Here's the link:

https://apnews.com/32171d5b5edb3babe25ba6edc4b505d6

Almost2late:
Nice to see they're still trying to find a cure, keeping fingers crossed and my eye on this one. Love to see if they will get similar results from the other participants in this research.
Thank you for sharing this.

xinyuan:
This is definitely exciting. Understandably, researchers are being very cautious about calling this any kind of cure. It really is too early, and the field is filled with disappointing cases.

I have an issue with the news portrayal. Both articles are initially misleading by suggesting intensified treatment only. Intensified treatment trials have been tried over and over in hopes of depleting the reservoir and causing a cure. Until now, these trials were negative and disappointing.

Yes, the patient was on triple therapy ART. Yes, they added Tivicay and the fusion inhibitor Selzentry. The real novelty was the inclusion of a vitamin B3 analog: nicotinamide (NOT niacin).

The idea was to use nicotinamide as a histone deacetylase inhibitor (HDAC), or the "Kick" in the "Kick and Kill" strategy. So, this isn't simply "intensifying therapies" but forcing viral replication to activate.

If his case pans out to be a true "functional" cure, then he could be the first documented proof of principle for the "Kick and Kill" approach.

The original clinical trial registration can be found here:
https://www.clinicaltrials.gov/ct2/show/NCT02961829

xinyuan:
Oh, wow. I'm getting a headache reading up on nicotinamide.

Some literature support it inhibiting sirtuin HDAC activity (in vitro / Petri dish). Others support it enhancing it (in vivo).

The latter is an active area of anti-aging research, along with other NAD+ precursors (e.g., niacin, nicotinamide riboside, nicotinamide mononucleotide). And then there are other effects on cell methylation processes.

It's interesting that other arms even used gold particles in hopes of depleting CD4 memory T-cells. Yet, no such similar case as his was found in those arms, even with one combining with nicotinamide. Not surprising, though, when you have only 5 patients in each group and chances of such a result are low.

I am hoping that his medical team figure out the exact process that led to his results. Then, it can be replicated in those of us with a similar biology. Otherwise, this case is the equivalent of winning a lottery (I mean, if one gets lucky and somehow eliminates / inhibits all the cells capable of making HIV ... ).

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