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Second infant reportedly cleared of HIV after early ART

BOSTON — There is now evidence from two infants that very early combination antiretroviral therapy administered to neonates may result in HIV infection remission, according to data presented at the 2014 Conference on Retroviruses and Opportunistic Infections.

Deborah Persaud, MD, of the department of pediatrics at The Johns Hopkins University School of Medicine, and colleagues conducted follow-up on a case presented last year that involved the “Mississippi baby” who was started on combination ART 31 hours after being born, which led to HIV remission after 23 months of being off ART treatment.

Persaud said another infant, who was born in Long Beach, Calif., also has been identified as having undetectable plasma HIV RNA levels through age 67 days after testing positive for HIV DNA at 4 hours of life (217 copies/mL of HIV RNA at 36 hours after birth). Combination ART began 4 hours after the infant was born, and no replication competent reservoir was detected at age 2.2 months. However, this child remains on ART, she said.

The original child from Mississippi, described during CROI 2013, was received with “skepticism and optimism,” Persaud said during a press conference, but the researchers felt it was important to provide follow-up on this child.

“To date, the child remains in remission and off ART, and there’s been no detectable rebound in plasma virus using standard clinical assays,” she said.

HIV DNA had been detected in the patient using sensitive DNA PCR assays; however, the clinical relevance remains unclear because there are no clinically detectable plasma viral load levels in the patient.

“On combination ART treatment, within 6 days, it became very difficult to detect for viral DNA in the blood cells of this child using standard assays,” Persaud said. “We’ve gone on to see whether replication competent reservoir exists in this child, and we’ve been unable to detect that.”

However, Persaud said the outcome with respect to remission in the patient from California is still unknown because the child remains on combination ART.

“What we can say from these two studies is there is a signal here that giving very early antiretroviral treatment in neonates restricts HIV spread to the point that it becomes difficult to detect infection,” Persaud said. “We believe it’s important for the field to begin to identify strategies and to be able to advise how to manage these very early treatments going forward.”

For more information:

Persaud D. Abstract #75LB. Presented at: CROI 2014; March 3-6, 2014; Boston.

Disclosure: Persaud reports no relevant financial disclosures.