For the first time has a patient beaten HIV with medications?

The man, a Brazilian from São Paulo, has undergone shock therapy with antivirals and nicotinamide and for 66 weeks has no longer had signs of HIV infection. Healing, however, is still to be demonstrated

(photo: Callista Images / Getty Images) After the Berlin and London patients, perhaps another person has defeated HIV. A team of clinical researchers from the Federal University of São Paulo (Brazil) presented the case of a 36-year-old patient diagnosed with AIDS since 2012 at the international AIDS conference 2020 (virtual, due to coronavirus pandemic), who after an experimental treatment very aggressive based on 5 antivirals and nicotinamide, it has shown no signs of infection for 66 weeks. If time and investigations confirmed healing, it would be the first success in the world with drug therapy - a far less risky and expensive approach than bone marrow transplantation, which is unworkable for all millions of patients worldwide.

The patient from San Paolo

The case is of a Brazilian man who in 2012 tested HIV positive, starting antiretroviral therapy after a couple of months - the one that allows people who have contracted the infection to control the virus and lead a normal life and not be infectious.

In 2015, this man has accepted, together with four other patients with the disease under control, to participate in a trial conducted by a team of Ricardo Diaz of the federal university of sao Paulo – the study that it planned to submit to a drug therapy, more aggressive , with the intention to eradicate once and for all the virus-eliminating reservoirs of infection in the body. Hiv is a virus that is particularly sneaky and can lurk undetected in some cells of the lymph nodes and the intestine, by integrating its genetic material into that of the cells; and, so far, no approach has succeeded in eliminating it completely.

The patient to St. Paul, therefore, took for 48 weeks to five antiretroviral (two more than in his ordinary regime), and nicotinamide , a molecule that, in theory, stimulates the infected cells which harbor the latent virus to wake it up again by being vulnerable. Then for the next three years is back to the routine therapy , up to suspend all treatments. To 66 weeks from the interruption of all treatments there is still no trace of a return of the virus, according to what was reported by the researchers, is not its genetic material in the blood of the patient and there are no immune reactions to antigen in lab tests.

you do Not speak (yet) of healing

A success? The manager of the clinical study itself makes clear: it is not known if the patient is really cured . There may be a current condition, and in time the virus could return. It happened in the past (a young patient gave to be healed but that has seen a return to the infection after two years), and also this man is the only one of the five that received the experimental treatment had a similar positive response. The other four have seen the return of viral load after interruption of antiretroviral therapies.

That the patient is really getting rid of hiv is a possibility , researchers say, which say they are optimistic: the only one among their patients to have had a different response in the treatment phase, the one where they found traces of the virus in the blood during the treatment – a sign, perhaps, that the nicotinamide has really awakened (even if I don't know in which way) the infected cells silences which were then removed.

However, they admit, it is much too soon to sing victory . You will need to do other tests , taking samples from the lymph nodes and intestine, for example, and make sure that indeed the patient has stopped taking the antiretroviral drugs (he says so, but the researchers want to be 100% sure). And wait to see what happens.

If the healing were to be confirmed, we still have to understand why the experimental therapy worked in one patient and not in others, and preparation for new clinical studies .