CROI 2014A man who contracted HIV perhaps five days before starting a pre-exposure prophylaxis (PrEP) regimen and who then received full antiretroviral (ARV) treatment an estimated 12 days after infection shows no sign of the virus several months later. The man was enrolled in The PrEP Demo Project, a program targeting high-risk men who have sex with men. Information from this case study was presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

The man tested negative through pooled RNA, 4th generation enzyme-linked immunosorbent (EIA) assay, and rapid antibody tests from samples drawn 21 and 13 days before he began taking Truvada (tenofovir/emtricitabine) as PrEP. The sample drawn the day he started PrEP showed that his RNA level was 220 copies, while the other two HIV tests conducted on that sample were negative, indicating a very early infection—an estimated five days old.

He took PrEP for seven days. Taking just two HIV medications, as are included in PrEP, instead of the standard three is against treatment protocol if someone is found to have HIV. But it took time for his RNA screen test to come back, so the investigators did not know he had an acute HIV infection during his first week on PrEP.  

Once his HIV infection was discovered, he was put on a conventional HIV treatment cocktail of Prezista (darunavir), Norvir (ritonavir) and Truvada.

The man’s HIV RNA levels dropped from the initial 220 to a read of 120 a week after he started PrEP, and then to below 40 about 27 days after infection. Since then, researchers have been unable to detect HIV in his body, using highly sensitive tests.

Researchers intend to try taking him off ARVs after a year.

The scientists are not able to conclude at this time how PrEP may have contributed to the apparent dissipation of the virus in the man’s body. They advise that programs prescribing PrEP should consider testing for acute HIV both before and during the use of PrEP and then to consider immediately switching to a full HIV treatment regimen in the event of HIV infection.