Some HIV-Infected People Develop Spontaneous Control of HIV After Short-Term HAART During Acute Infection

While the initiation of temporary HAART during primary (i.e., "acute" or "early") HIV infection occasionally results in partial HIV control, after treatment cessation the vast majority of patients eventually experience viral load rebound.

This poster describes the case of a patient who was treated with HAART at the Johns Hopkins University School of Medicine during primary infection. He had meningoencephalitis and an HIV viral load over 750,000 copies/mL. But he has been able to maintain an undetectable viral load for nine years since he stopped HAART, making this the longest viral control ever reported in someone who stopped HIV treatment.

Surprisingly, his virus is dual tropic (R5/X4), and none of his immune parameters show any special controlling factors.

Meanwhile, another study presented right next to the Johns Hopkins poster measured long-term outcomes (over 10 years) in French patients who started HAART during their acute HIV infection between the years of 1995 and 2000. The median time on HAART was 2.2 years, after which they stopped therapy.

Of the 45 people not lost to follow-up (58 in total were originally enrolled and treated during acute infection), eight have still not resumed HAART after an average of more than 10 years. Two of those patients have maintained an undetectable HIV viral load since they stopped HAART; they have undetectable virus in all immune cells tested, but they have detectable virus in lymphoid rectal cells, an important reservoir. The remaining patients, who are still off therapy, have an average viral load under 2,500 copies/mL and a CD4+ cell count over 350 cells/mL.

For more information, read CROI poster 357, "Prolonged Control of Replication-competent Dual-tropic HIV-1 following Cessation of HAART," presented by Maria Salgado, and poster 358, "Long-term Control of HIV Reservoir after a 2-year ART Course at Acute Infection," presented by Alain Lafeuillade.