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

[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 ... ).

[Ptrk3]

Another story on the subject, this one from the July 7, 2020, edition of (online) NAM aidsmap:

excerpt:

After our patient got the intensified regimen, there were signs that his HIV might be starting to disappear. Tests to detect HIV RNA and DNA drew blanks. Attempts to cultivate virus from some of his lymphocytes failed. The levels of antibodies to HIV in his blood started to decline, indicating there was very little virus to stimulate their production.

So he was taken off all his drugs in March 2019. And since then his HIV has not reappeared and his antibodies have continued to decline. Fifteen months without a viral rebound is almost unprecedented in any chronically infected patient who didn't get very early antiretroviral therapy.

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Link to story:

https://www.aidsmap.com/news/jul-2020/has-someone-been-cured-hiv-cheap-simple-drug-regimen

[MitchMiller]

I used to take nicotinamide.  It's a popular anti-aging supplement.  However, I didn't feel any different and it's expensive.  So I quit taking it.

I put it back on my Amazon wish list, so maybe I'll try it again.  I've read there's only one manufacturer of the active ingredient (at least two years ago), so all of the brands are pretty much the same.

[Almost2late]

I used to take nicotinamide.  It's a popular anti-aging supplement.  However, I didn't feel any different and it's expensive.  So I quit taking it.

I put it back on my Amazon wish list, so maybe I'll try it again.  I've read there's only one manufacturer of the active ingredient (at least two years ago), so all of the brands are pretty much the same.

Funny, I had never heard of niacinamide until this Brazilian cure research story. So I also bought a bottle of niacinamide time released tablets 500 mg to guinea pig myself. Been on it a month and I have noticed some differences.. more energy and about three nights of sweats, which I haven't had in a long time.

I'm under no illusion that this will cure my hiv but maybe those sweats are the virus coming out of hiding. I'll be due for labs in a couple of weeks and see if any significant changes occurred.

Sincerely, Dr.Jekyll 👨‍⚕️

[J.R.E.]

I used to take nicotinamide.  I

I used to take it as well,( also Plain Niacin) Recommended by my dermatologist, to possibly help with keratosis and minor pre skin cancers that I was having at the time. I am not sure if it really worked or not.  I still see a dermatologist, once a year, but overall I am doing OK. Not that many years ago I was seeing a dermatologist, every 6 months, and could always count on my face looking pok-a- dotted, with all the freezes that were done.

The plain Niacin supplement, that I used to take caused quite a bit of flushing in me, after I took it. I believe the Nicotinamide, reduces that flushing effect.

Did they mention the dose of Nicotinimide given ? I am going to have to re read the article.


Ray

[Almost2late]

Did they mention the dose of Nicotinimide given ? I am going to have to re read the article.

'He was one of five people in the study to be randomized to receive the integrase inhibitor dolutegravir (Tivicay, ViiV Healthcare), the CCR5 receptor inhibitor maraviroc (Selzentry, ViiV Healthcare), and twice-daily nicotinamide 500 mg, a form of vitamin B₃, in addition to his regular regimen for 48 weeks."..

https://www.medscape.com/viewarticle/933531

[Almost2late]

Update to this thread, the Brazilian man is HIV positive again..

São Paulo patient experiences apparent viral rebound a year and a half after stopping HIV treatment

A Brazilian man who last summer had no evidence of remaining HIV after more than 15 months off antiretroviral therapy once again had detectable viral load a few months later, according to a report last week at the virtual Conference on Retroviruses and Opportunistic Infections (CROI). Work is underway to determine whether he experienced viral rebound or reinfection...

https://www.aidsmap.com/news/mar-2021/sao-paulo-patient-experiences-apparent-viral-rebound-year-and-half-after-stopping-hiv