{"id":50898,"date":"2025-04-12T19:55:10","date_gmt":"2025-04-12T19:55:10","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=50898"},"modified":"2025-05-22T13:38:46","modified_gmt":"2025-05-22T13:38:46","slug":"bite-size-croi-2025","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/50898","title":{"rendered":"CROI 2025: LAPTOP, EC rebounds after 32 years, two more HSCT cures"},"content":{"rendered":"<p><strong>Simon Collins, HIV i-Base<\/strong><\/p>\n<p><strong>The following short reports link to important posters and presentations that should now be available online.<\/strong><\/p>\n<p>Further studies will be added to these reports this week.<\/p>\n<ul>\n<li>LAPTOP study: INSTI- vs PI-based ART in very advanced HIV<\/li>\n<li>Long-term elite controller becomes detectable after 32 years<\/li>\n<li>Two new cure cases following stem cell transplants<\/li>\n<\/ul>\n<h2>LAPTOP study: INSTI- vs PI-based ART in very advanced HIV<\/h2>\n<p><strong>Results from a large randomised open-label European study reported bictegravir\/FTC\/TAF (B\/F\/TAF) to be non-inferior to darunavir\/cobicistat\/F\/TAF (D\/C\/F\/TAF) in 442 participants starting ART during advanced HIV infection. This was an independent investigator study as part of the NEAT network.<\/strong><\/p>\n<p>This was based on a composite primary endpoint of viral load &gt;50 c\/mL at week 48, viral reductions &lt;1 log by week 12 and clinical events. The failure rate was relatively high at 23% vs 33% in the modified ITT analysis [adj HR 0.70 (95%CI: 0.48 to 1.00), p=0.052] in favour of B\/F\/TAF.<\/p>\n<p>Viral failure and insufficient viral response were both significantly less common with B\/F\/TAF: 13% vs 23% (p=0.013) and 12% vs 23% (p=0.014), respectively. Side effects were also less common although this was driven by low-level grade 1 and 2.<\/p>\n<p>This was notable for being a very advanced cohort. The median CD4 count was only 41 (IQR: 17 to 79) and 85% had baseline CD4 less than 100 cells\/mm3. Median viral load was 400,000 with 44% (n=197) &gt;500,000 copies\/mL. Participants were 80% men, 62% white and 18% Black.<\/p>\n<p>Please see online poster for further details, although resistance data and responses to second-line were not yet available.<\/p>\n<p>Ref: Integrase Inhibitor- Versus Protease Inhibitor-Based Therapy for People With Advanced HIV Disease. CROI 2025. Poster abstract 658.<br \/>\n<a href=\"https:\/\/www.croiconference.org\/abstract\/3751-2025\/\">https:\/\/www.croiconference.org\/abstract\/3751-2025<\/a>\u00a0(abstract and poster)<\/p>\n<h2>Long-term elite controller becomes detectable after 32 years<\/h2>\n<p><strong>Details of an elite controller in Spain (heterozygous for CCR5 delta-32) who was diagnosed in 1985 and with a recorded HIV history from 1990. <\/strong><\/p>\n<p>Subsequent longitudinal viral load results (n=16 from 19 to 37 years after diagnosis) were persistently undetectable except for four low level blip results &lt;150 copies\/mL.<\/p>\n<p>Viral load significantly rebounded in December 2016 and he started ART in October 2021 with a CD4 count &lt;500 cells\/mm<sup>3<\/sup>.<\/p>\n<p>The poster reports viral changes over time, including dynamic changes in the reservoir with HIV DNA showing that 95% of these cells contained defective virus.<\/p>\n<p>Ref: Loss of Virologic Control 32 Years After HIV-1 Diagnosis in an Exceptional Elite Controller. CROI 2025. Poster 494.<br \/>\n<a href=\"https:\/\/www.croiconference.org\/abstract\/2382-2025\/\">https:\/\/www.croiconference.org\/abstract\/2382-2025<\/a> (abstract and poster)<\/p>\n<h2>Two new cure cases following stem cell transplants<\/h2>\n<p><strong>Two posters presented details about two cases of HIV cure following haematopoietic stem cell transplantation (HSCT).<\/strong><\/p>\n<p>The first case was notable for viral load becoming detectable and rebounding after HSCT which subsequently became undetectable.<\/p>\n<p>This was a 67-year-old man with acute myeloid leukemia (AML) who received successful reduced-intensity HSCT from a 10\/10 CCR5\u220632\/\u220632 matched unrelated donor.<\/p>\n<p>After 12 months wild-type CCR5 DNA was undetectable in PBMCs and HIV antibodies levels were similar to HIV negative controls. However, after stopping ART, viral load rebounded to 780 copies\/mL at week 8 but there was no cell-associated RNA or DNA in PBMCs (&lt;0.14 copies\/million) which remained 100% donor.<\/p>\n<p>ART was restarted for the next two years, and after a second interruption viral load has remained undetectable for 7 months.<\/p>\n<p>The second case, the Oslo patient, is a 58-year-old male who had been diagnosed and on ART for 14 years and who underwent HSCT for myelodysplastic syndrome.<\/p>\n<p>This case was notable because the donor was his HLA-identical brother who was homozygous for CCR5 delta-32 compared to the heterozygous recipient who carried CCR5 delta 32\/wild-type. He developed severe acute graft versus host disease (GvHD) and had complete donor chimerism in peripheral blood by day 90.<\/p>\n<p>Post HSCT viral load HIV RNA remained undetectable and ART was stopped after two years. No replication competent virus was detected in 65 million CD4 cells.<\/p>\n<div><\/div>\n<div>References<\/div>\n<div>Rubinstein P et al. Sustained HIV Remission Despite Transient Rebound Viremia After a CCR5\u220632\/\u220632 Stem Cell Transplant. CROI 2025. Late breaking poster 531.<br \/>\n<a href=\"https:\/\/www.croiconference.org\/abstract\/3806-2025\/\"><strong>https:\/\/www.croiconference.org\/abstract\/3806-2025<\/strong><\/a><span> (abstract and poster)<\/span><\/div>\n<div>\n<div>\n<p>Tr\u00f8seid M. HIV Remission After Allogeneic Hematopoietic Stem Cell Transplant From CCR5\u039432\/\u039432 Sibling Donor. CROI 2025. Late breaking poster 532.<br \/>\n<a href=\"https:\/\/www.croiconference.org\/abstract\/3818-2025\/\">https:\/\/www.croiconference.org\/abstract\/3818-2025<\/a>\u00a0(abstract and poster)<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Simon Collins, HIV i-Base The following short reports link to important posters and presentations that should now be available online. Further studies will be added to these reports this week. LAPTOP study: INSTI- vs PI-based ART in very advanced HIV &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,3,41],"tags":[339],"class_list":["post-50898","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-antiretrovirals","category-treatment-strategies","tag-croi-2025"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/50898","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=50898"}],"version-history":[{"count":20,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/50898\/revisions"}],"predecessor-version":[{"id":51105,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/50898\/revisions\/51105"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=50898"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=50898"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=50898"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}