Functional cure and seroreversion after advanced HIV disease following 7-years of antiretroviral treatment interruption

Background: Very early antiretroviral treatment (ART) during primary infection can lead to functional cure in a subset of patients called post-treatment controllers. However, there is no evidence that functional cure can be reached after chronic HIV-1 infection. We report a 51-year old female diagnosed with advanced HIV-1 infection that has no detectable HIV-1 viremia and seroreverted after 7 years off-ART.
Methods: Case report of a patient hospitalized in 1996 with wasting syndrome and probable toxoplasma encephalitis. Two HIV-1 positive ELISA tests and a positive Western Blot (WB) confirmed HIV-1 infection. She was treated with pyrimetamin and clindamicin and started on zidovudine, didanosine and nevirapine soon after diagnosis. Pre-treatment HIV-1 viral load (VL) and CD4+ T cell count are not available. After two weeks on ART, her CD4+ T cell count and VL were 164 cells/µl and 2,200 RNA copies/mL (RT-PCR), respectively. She recovered without neurologic sequel. She developed virological failure after one year with VL 36,000 copies/mL (Nasba HIV-1) and CD4+ T cell count 490 (32%) cells/µl. ART was changed to stavudine, lamivudine and indinavir in Nov 1997 and, thereafter, VL persisted < 50 RNA copies/mL. ART was interrupted in 2007 due to dyslipidemia and lipodystrophy. She remains undetectable with successive VLs less than 400, 50 or 20 copies/mL depending on the available test (Roche® Standard or Ultrasensitive RT-PCR Amplicor -automated Cobas-, and Cobas/Ampliprep, respectively).
Results: CD4+ T cell count remained stable between 568-885 cells/µl since 2007. Current CD4/CD8 ratio is 1.4 and VL by Cobas/Ampliprep and bDNA CHIRON HIV-1 RNA 3.0 was < 20 and < 50 RNA copies/mL, respectively. Proviral HIV-DNA was not detected in PBMCs by PCR targeting gag, pol and env genes. No CCR5 delta 32 deletion was detected. HLA-B (Luminex) was 41;58. HIV-1 ELISA and WB were re-tested, resulting no reactive in two separate samples.
Conclusions: This is the first report of a functional cure case that also seroreverted after advanced HIV disease and suggests that post-treatment control could be achieved following chronic HIV-1 infection. Further studies are undergoing to assess HIV-1 reservoirs in this patient.

A. Urueña1, A. Mangano2, R. Arduino3, P. Aulicino2, I. Cassetti1
1Helios Salud, Ciudad Autónoma de Buenos Aires, Argentina, 2Hospital de Pediatría 'Prof. Dr. J.P. Garrahan', Laboratorio de Biología Celular y Retrovirus-CONICET, Ciudad Autónoma de Buenos Aires, Argentina, 3The University of Texas Health Science Center, Houston, United States