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Background:  HIV antibody reversion among patients treated with highly active antiretroviral therapy (HAART) during acute/early HIV infection has been reported. However, reversion of the antibody status together with disappearance of HIV RNA and negative HIV culture 4 years after stopping HAART was not yet been reported in a documented HIV-positive patient. In this study we report on such a patient.

Methods: Three antibody assays (Abbott recombinant HIV-1/HIV-2 third-generation EIA; Abbott HIV 1/2 gO [MEIA]; Cambridge Biotech HIV-1 Western Blot [WB] Kit [Ortho]) were performed at diagnosis and on frozen plasma samples at different time points. Quantitative HIV RNA level and proviral DNA were performed using Nuclisense assay (BioMerieux) and home-made reverse transcriptase-polymerase chain reaction (RT-PCR), respectively. Tissue cultures of blood and semen samples were performed in SupT1 cells.

Results:  The patient was diagnosed in 1995 as HIV antibody positive (ELISA and WB) during blood donation. He was at risk for contracting the virus due to unprotected sex during work in Africa. Antibodies and RNA were measured independently in 2 different laboratories. Soon after diagnosis viral load was 4,000 copies/mL. Two years later, viral load measurements were 29,000 and 24,000 copies/mL. CD4+ T-cell count was 856 cells/mL.  HAART was initiated, and viral load was undetectable 4 months later. CD4+ cell count did not change significantly. Three years after initiating HAART, HIV antibody test was performed (for enrollment to a clinical study) and the result was negative. HAART was discontinued at that time (for structured treatment interruption study). From then to the present time, during the 4 years in which the patient did not receive antiretroviral treatment, anti-HIV antibody tests remained negative and viral load remained undetectable. HIV-RNA tests have been consistently negative and cell cultures from blood and semen tested negative as well.

Conclusion: We report here for the first time a case in which a patient, who had been unequivocally infected with HIV and then treated with HAART, showed no evidence of infection after treatment was discontinued and remained apparently infection-free at the time of reporting 4 years later.

Keywords: reversion HIV antibody ; negative RNA; negative culture