Treating HIV-infected children briefly in infancy may lower the need for life-long therapy.
Image source: National Institutes of Health (NIH)
The research adds to a growing body of evidence suggesting that early treatment of the virus in infancy may suppress HIV to undetectable levels, which could reduce the need for life-long drug treatment.
Dr. Avy Violari, head of pediatric research at the Perinatal HIV Research Unit at the University of the Witwatersrand in Johannesburg, South Africa, co-led the study with Mark Cotton, head of the Division of Pediatric Infectious Diseases at Stellenbosch University, also in South Africa.
At the conference, the researchers presented the case of the South African child, who was diagnosed with HIV infection in 2007, at just 32 days old. The child was enrolled in the Children with HIV Early Antiretroviral Therapy (CHER) clinical trial, which is funded by the National Institute of Allergy and Infectious Diseases (NIAID).
The infants in the trial were randomly assigned to receive either deferred antiretroviral therapy (ART) or early ART for 40 or 96 weeks, at which point the treatment would be stopped.
The South African child was among the 143 infants who received early ART treatment for a total of 40 weeks.
Early ART treatment tied to HIV remission
Before treatment, the child's levels of HIV in the blood, or viral load, were very high. At around 9 weeks of age, the child started ART, which suppressed the virus to undetectable levels. The child's treatment was halted at 40 weeks, and their immune health was monitored during years of follow-up examinations.
Investigators assessed the child's immune health and the presence of HIV at age 9.5 years. They found a reservoir of virus in a tiny portion of immune cells, but otherwise no evidence of HIV infection was detected and there were no associated symptoms.
While the researchers detected a trace of response by the immune system, they were unable to identify any HIV capable of replicating. It was confirmed that the child does not have genetic characteristics connected with spontaneous HIV control, which suggests that the 40 weeks of ART received during infancy may have played a key role in achieving HIV remission.
Since the initial treatment, the child has maintained undetectable levels of HIV. "To our knowledge, this is the first reported case of sustained control of HIV in a child enrolled in a randomized trial of ART interruption following treatment early in infancy," says Dr. Violari.
Third prolonged drug-free remission case
This child's case is the third instance of long-term HIV remission without ongoing drug therapy. In 2010, a child known as the "Mississippi Baby" received anti-HIV treatment 30 hours after birth. After ceasing treatment at around 18 months of age, the virus was controlled without drugs for 27 months before reappearing in her blood.
In 1996, a French child was born with HIV and began anti-HIV treatment at 3 months old. In 2015, researchers reported that, after therapy had been stopped sometime between the ages of 5.5 and 7 years, the child was in HIV remission without drugs for more than 11 years.
"Further study is needed to learn how to induce long-term HIV remission in infected babies," explains Anthony S. Fauci, director of the NIAID.
"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 HIV disease."
Anthony S. Fauci
"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," concludes Caroline Tiemessen, Ph.D., head of cell biology at the Centre of HIV and STIs of the National Institute of Communicable Diseases in Johannesburg, South Africa.