Research presented this morning at the International AIDS Conference 2020 showed that a 35-year-old man in Brazil may be the first to experience long-term remission from HIV with only a cocktail of antiviral drugs.
Previously, there have only been two cases — in Berlin and in London — where a person living with HIV experienced long-term remission for over a year, but both were as a result of bone marrow transplants.
It should be noted that the term “cure” is difficult to navigate. Historically, the virus has displayed long-term remission in many cases but it typically doesn’t stay dormant for long. The virus is known to reside in HIV reservoirs, where it can stay inactive for weeks or months at a time before “waking up” and continuing to infect T cells.
According to The New York Times, the unidentified Brazilian patient showed no signs of HIV in blood tests after taking part in a 2016 clinical trial where he received three specific antiretroviral drugs for 48 weeks straight.
He returned to his routine antiretroviral therapy after the trial, but reportedly stopped his meds altogether in March 2019.
Since that time, the Brazilian patient has been tested every three weeks and has shown no sign of HIV, researchers say. Still, while being in remission for over a year is quite monumental, these results are preliminary and shouldn’t be considered a “cure” just yet.
“These are exciting findings, but they’re very preliminary,” Dr. Monica Gandhi, an HIV expert at the University of California, San Francisco, told the Times, adding that no drug “has worked so far in terms of long-term remission. I’m not even sure this has worked. It’s one patient, so I think we can’t say we can achieve remission this way.”
Dr. Steve Deeks, an HIV researcher and Gandhi’s colleague at UCSF, implied there is also a possibility the Brazilian patient continued his antiretroviral drugs without informing the study team.
“This would not be unprecedented.” he explained. “There will be a lot of buzz, a lot of controversy about this part — everyone’s going to be skeptical. Am I skeptical? Of course. Am I intrigued? Absolutely.”
Of course, it’s too soon to say whether the Brazilian patient has truly been “cured.” Any narrative toward that end will only give false hope.
Last year, there were countless of reports about the London patient, Adam Castillejo, a man who’d previously been HIV-positive but showed no trace of the virus after more than 18 months of being off antiretrovirals. Nearly a decade prior, in 2007, the Berlin patient, Timothy Ray Brown, was also hyped to be cured of HIV.
Castillejo and Brown's success were as a result of a bone marrow transplant. It is believed that both are still in remission. Recently, Brown spoke about practicing PrEP, an HIV prevention strategy that when taken routinely makes it virtually impossible to contract HIV.
In both cases, Castillejo and Brown's bone marrow donors carried a rare mutation called Delta32 that made their body immune to contracting HIV. Very few people have this genetic variation, and some scientists think it was inherited from ancestors who survived the bubonic plague in Europe.
About 1 percent of Caucasians have Delta32, and it is even rarer in Native Americans, Asians, and Black people. A 2005 report indicated that 1 percent of people descended from Northern Europe are virtually immune to AIDS.