IAS 2017: Child maintains HIV remission without antiretroviral therapy

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A 9-year-old South African child diagnosed with HIV at an early age has been reported to have suppressed the infection for 8.5 years without the continued use of antiretroviral therapy (ART). The case, reported at the 9th International AIDS Society Conference on HIV Science (23–26 July 2017) in Paris (France) is one of three instances whereby HIV remission has been sustained without dependency on ART or other anti-HIV drugs.

A previous case, the “Mississippi Baby” (born in 2010) was a two-year-old child who had received ART from birth for 18 months until the therapy was stopped and remission was monitored. During this period, the child was declared ‘functionally cured’ as the level of detectable HIV (viral load) in their blood was extremely low, nevertheless after 2 years, the infection became detectable and treatment was resumed.

Similarly, a French child born with HIV in 1996 was able to sustain remission of the HIV infection for over 12 years following stoppage of ART when the child was between 5.8 and 6.8 years old.

In this case, the South African child was enrolled into the Children with HIV Early Antiretroviral Therapy clinical trial funded by the National Institute of Allergy and Infectious Diseases (NIAID; MD, USA) following diagnosis of HIV infection at 32 months.

The child was amongst a group of 143 other HIV-infected infants who received early ART for 40 weeks. After this period, the treatment was paused and viral load in the child’s blood was closely monitored.

Before starting ART, the viral load of the child was very high, however, after treatment was stopped follow-up examinations revealed that the HIV in the child’s blood had become nearly undetectable and immune health was good. Further, examinations of the child at 9 years old demonstrated that remission had been maintained and the child had developed a healthy level of key immune cells.

Dr Caroline Tiemessen, from the National Institute of Communicable Diseases (Johannesburg, South Africa), who is currently studying the child’s immune health commented: “We believe there may have been other factors in addition to early ART that contributed to HIV remission in this child, by further studying the child, we may expand our understanding of how the immune system controls HIV replication.”

The sentiment expressed by Dr Tiemessen for further research is also shared by Dr Anthony S Fauci, Director of NIAID who stated: “Further study is need to learn how to induce long-term HIV remission in infected babies, however, this new case strengthens our hope that by treating HIV-infected children for a brief period beginning in infancy, we may be able to spare them the burden of life-long therapy and the health consequences of long-term immune activation typically associated with the HIV disease.”

There is currently an ongoing National Institutes of Health clinical trial (IMPAACT P1115) that is testing whether giving early ART to HIV-infected newborns within 48 hours of birth can enable long-term control of HIV replication after the stoppage of treatment. The findings from that study and this case could have profound implications on future HIV-infection management in infants.

Sources: A Violari et al. Viral and host characteristics of a child with perinatal HIV-1 following a prolonged period after ART cessation in the CHER trial. 9th IAS Conference on HIV Science, Paris (2017); www.nih.gov/news-events/news-releases/child-living-hiv-maintains-remission-without-drugs-since-2008

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