Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection
Brawley D et al. Journal of the International AIDS Society 2012, 15(Suppl 4):18329
http://www.jiasociety.org/index.php/jias/article/view/18329 | http://dx.doi.org/10.7448/IAS.15.6.18329
Poster Abstract P64
Viral load rebound in presumed elite controllers: a small case
series of the potential use of non-prescribed HAART in African
patients
Brawley, D; Bell, D; Peters, E and Fargie, F
Brownlee Centre, Gartnavel General Hospital, Infectious Diseases, Glasgow, UK.
Introduction
HIV elite controllers are rare with an incidence of B1/300 [1]. We report 4 cases of presumed elite control with subsequent viral
load rebound possibly due to non-prescribed HAART. Case 1: A 37-year-old African woman trafficked to the UK was diagnosed
HIV-positive with viral load (VL) B40 copies/mL and CD4 count of 436 cells/cmm. She denied prior diagnosis and was presumed
an elite controller until a rise in VL to 26,5205 copies/mL 6 months later (Table 1).
Time from diagnosis
0
1
3
6
6
month
months
months
months
CD4 (cells/cmm)
Viral load (copies/mL)
436 (26%)
424 (18%)
N/A
387 (29%)
264 (18%)
B40
B40
B40
265,205
338,291
A resistance test reported HIV-1 subtype C with a minor protease inhibitor mutation (A71T). It was subsequently disclosed she
was given unidentified tablets by traffickers. Case 2: A 31-year-old African woman presented 37 weeks pregnant and was
diagnosed HIV-positive with VL 147 copies/mL and CD4 count of 1065 cells/cmm. She denied prior diagnosis, however stated an
African doctor visited her ex-partner’s home and supplied tablets identified as lopinavir/ritonavir and zidovudine/lamivudine.
Clinics in this area were contacted but had no record of this patient. There was a rise in VL with a resistance test reporting HIV-1
subtype C/D with no mutations. Case 3: A 53-year-old African woman presented 6 weeks after a sexual assault in her home
country and was diagnosed HIV-positive with VL B40 copies/mL and CD4 count of 609 cells/cmm. She denied prior diagnosis but
stated her employers gave her unidentified tablets after the assault. Over 3 months VL increased to 390,751 copies/mL (Table 2).
Time from diagnosis
0
1
2
4
6
month
months
months
months
CD4 (cells/cmm)
Viral load (copies/mL)
609 (30%)
763 (29%)
N/A
616 (19%)
237 (18%)
B40
B40
417
390,751
67,833
A resistance test reported HIV-1 subtype A with no mutations. Case 4: A 42-year-old African man was diagnosed HIV positive
with VL 269 copies/mL and CD4 count of 562 cells/cmm. A resistance test reported HIV-1 subtype B with minor PI and NRTI
mutations (L10V and V118L respectively). HIV parameters remained stable until 20 months later with an increase in VL to
1,463,132 copies/mL (Table 3).
Published 11 November 2012
Copyright: – 2012 Brawley D et al; licensee International AIDS Society. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
1
Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection
Brawley D et al. Journal of the International AIDS Society 2012, 15(Suppl 4):18329
http://www.jiasociety.org/index.php/jias/article/view/18329 | http://dx.doi.org/10.7448/IAS.15.6.18329
Time from diagnosis
0
3 months
6 months
9 months
14 months
20 months
20 months
CD4 (cells/cmm)
562
454
456
492
473
279
299
(33%)
(37%)
(29%)
(31%)
(27%)
(13%)
(12%)
Viral load (copies/mL)
269
810
1110
1013
199
1,463,132
1,070,823
A resistance test excluded super-infection reporting a similar sequence and no new mutations. Co-existing pathology was also
excluded. He subsequently disclosed taking medication supplied by his family but denied this was HAART.
Conclusion
The viral load rebound seen in these cases may be due to a viral or immune mediated phenomenon; however, the possibility of
non-prescribed HAART has to be considered. Home test kits for HIV are widely available and there are reports of counterfeit
HAART in the developing world [2]. The HIV community has to be vigilant in reporting cases of this nature which create many
anxieties regarding toxicity and resistance.
References
1. Walker BD. Elite control of HIV infection: implications for vaccines and treatment. Top HIV Med. 2007;15:1346.
2. Amon JJ. Dangerous medicines: unproven AIDS cures and counterfeit antiretroviral drugs. Global Health. 2008;4:5.
2