Very Early Antiretroviral Therapy Failed to Eradicate HIV

Strong evidence suggests that starting antiretroviral therapy (ART) during acute HIV infection reduces the size of the HIV reservoir. Now, researchers describe the outcomes of two men who were treated during hyperacute HIV infection, recognized when they were initiating ART intended as preexposure prophylaxis (PrEP).

Participant A was started on PrEP after previous visits when HIV testing was negative. On day 7 after initiating PrEP, his treatment-day zero HIV RNA result returned at 220 copies/mL even though the fourth-generation HIV test was negative; he was immediately changed to four-drug ART. (In retrospect, he was estimated to have been infected 10 days before starting prophylactic ART.) Over the next few years, no virus could be found …