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Child with HIV suppresses virus for more than 8 years without ART
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A South African child who was diagnosed with HIV as an infant has suppressed the virus for the past 8 1/2 years without treatment, researchers said.
The child was diagnosed with HIV in 2007 at the age of 1 month and received early ART as part of the Children with HIV Early Antiretroviral Therapy (CHER) clinical trial. Although treatment was stopped after 40 weeks, the patient has remained in remission, according to findings presented today at an International AIDS Society conference in Paris.
It appears to be just the third time that sustained remission has been reported in a child who received early ART, the NIH said. Two previous cases involved the so-called “Mississippi Baby,” who was in remission for over 2 years after receiving early treatment before the virus rebounded, and a French child who controlled the virus more than 11 years after stopping treatment.
“Further study is needed to learn how to induce long-term HIV remission in infected babies,” Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), which funded the CHER trial, said in a statement. “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.”
Between 2005 and 2011, researchers in the CHER trial randomly assigned HIV-infected infants to receive either deferred ART or early limited ART for 40 or 96 weeks. The patient described Monday was enrolled in the trial after being diagnosed with HIV at the age of 32 days, according to researchers. The patient’s viral load was greater than 750,000 copies/mL 39 days after birth.
ART began between 8 and 9 weeks after birth and continued for 40 weeks, the researchers said. After 24 weeks, viral load was measured to be below 50 copies/mL. After interruption and during a 6-month follow-up, it was below 20 copies/mL.
At the age of 9 1/2, the child was clinically asymptomatic and was reported to have remained in good health, the researchers said. Moreover, a recent analysis of stored blood samples showed that the child has maintained an undetectable level of HIV. Recent tests also have detected no evidence of HIV infection beyond a small reservoir of virus and no symptoms of HIV infection, according to the NIH. The tests showed a trace immune system response to the virus but no HIV capable of replicating.
According to a press release, researchers found that the child does not have genetic characteristics associated with spontaneous control of HIV, suggesting that early ART in infancy may be the key to achieving remission, although researchers believe there are other factors in this particular case.
“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,” Avy Violari, FCPed, head of pediatric research in the Perinatal HIV Research Unit at the University of the Witwatersrand in Johannesburg, South Africa, said in the release. – by Gerard Gallagher
Reference:
Violari A, et al. Viral and host characteristics of a child with perinatal HIV-1 following a prolonged period after ART cessation in the CHER trial. Presented at: IAS Conference on HIV Science; July 23-26, 2017; Paris.
Disclosure: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.
Perspective
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Deborah Persaud, MD
It usually takes 2 to 4 weeks for patients to experience viremic relapse or return of HIV RNA in the blood. The curious feature is that the virus returns to the same level that was present before ART is started. Almost everyone — except for cases like the South African child, “Mississippi baby” and French adolescent — rebound within 2 to 4 weeks of stopping antiretroviral drugs. This happens to everyone: infants, children, adolescents and adults. This also happens if you are treated for 6 months or 10 or more years; in other words, controlling HIV for even a decade does not change this trajectory. This feature is what makes cases of remission distinct and promising.
The findings give us clues that there are a few individuals who can defeat HIV by altering its usual process of persistence.
There were some unique features in this case. It appears as if the viral load dropped before ART was started. In perinatal infection, infancy viral control to that degree does not usually occur within the first months of infection without antiretroviral drugs. Infection is rather progressive and life-threatening in the first year of life. Also, the relatively short treatment of only 40 weeks that led to the outcome of restricting HIV reservoirs is unusual within the first year of treatment. There are certain adults (1% of infected adults) who have protective genetic backgrounds (HLA-B27, HLA-B57) that confer the elite controller status; these infected persons control HIV without antiretroviral drugs and have robust HIV-specific immune responses. These were not detected in this child.
There are currently several NIH-funded clinical trials of very early ART to restrict HIV reservoirs and enable remission in perinatally infected children. These cases, including the “Mississippi baby” and French adolescent, provide additional hope for this research agenda toward sparing children and adolescents a lifetime of ART.
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