HIV-Infected Child Maintains Remission Without ART Since 2008

Although progress has been made in reducing the number of new HIV infections among children between 0 and 14 years of age, the number of children infected on an annual basis on a global scale is still “unacceptably high.”

New research reported at the 9th International AIDS Society (IAS) Conference on HIV Science in Paris, France, however, is leaving researchers hopeful that these children may be spared the lifelong burden of therapy as well as the associated immune health consequences.

This hope comes in the form of a 9-year-old South African child who was diagnosed with the virus at just 1 month of age. The child received early antiretroviral therapy (ART) during infancy, achieved viral suppression, and has maintained remission without receiving any drugs since 2008, according to the official press release.

The child had been enrolled in a clinical trial, called “Children with HIV Early Antiretroviral Therapy,” or CHER, which was funded by the National Institute of Allergy and Infectious Diseases (NIAID). The trial looked at HIV-infected infants who were randomly assigned to one of two groups. One group of children received deferred ART, while the other group received early, limited ART for the duration of 40 or 96 weeks. The South African was one of 143 infants who received early ART for the duration of 40 weeks.

Before receiving ART, the child presented with a high viral load, but after treatment, by the time the child was around 9 weeks of age, viral suppression was achieved, according to the press release. After 40 weeks, the researchers stopped the treatment and kept a close eye on the infant’s “immune health.” During follow-up examinations over the course of several years, the child was reported to have remained in “good health.” It is noted that it is “not standard practice in South Africa to monitor viral load in people who are not on ART,” but “recent analyses of stored blood samples taken during follow-up showed that the child has maintained an undetectable level of HIV.”

At 9-and-a-half years of age, the researchers performed laboratory and clinical studies dedicated to looking at the child’s immune health and HIV presence. Their findings, according to the press release, were as follows:

• Other than a reservoir of virus that was integrated into a tiny proportion of immune cells, they did not detect evidence of infection.
• The child had a healthy level of immune cells, had an undetectable viral load, and presented with no associated symptoms.
• A trace of immune system response to the virus was detected, but no HIV were capable of replication.

Furthermore, the child did not exhibit any genetic characteristics associated with spontaneous control of the virus, which suggests that “40 weeks of ART provided during infancy may have been key to achieving HIV remission.”

“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,” coleader of the reported case and CHER trial, Amy Violari, FCPaed, said in the press release. Caroline Tiemessen, PhD, whose laboratory is analyzing the child’s immune system, added that they believe that there may be other factors at play here in addition to the early ART that resulted in HIV remission. They hope to find out more by further studying the child.

This is not the first time that a child who received treatment early on in their lives achieved prolonged control of the virus after stopping treatment. The “Mississippi baby,” who was born with the virus in 2010, received treatment just 30 hours after birth, and stopped the treatment at about 18 months of age. This child was able to control the virus without any drugs for a whopping 27 months before it was detected in her blood. Researchers reported another similar case in 2015, when a French child born with the virus in 1996 started treatment at 3 months of age and stopped treatment between 5.5 and 7 years of age. That child achieved prolonged control of the virus without drug assistance “more than 11 years later,” according to the press release.

“Further study is needed to learn how to induce long-term HIV remission in infected babies,” Anthony Fauci, MD, director of the NIAD, of the National Institutes of Health said in the press release. “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.”