Perinatally infected HIV patient maintains remission 11 years after therapy

Long-term remission appears to be achievable for children born with HIV-1 and treated at an early age, according to data presented at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.

Asier Saez-Cirion, PhD, assistant professor at the Institut Pasteur, Paris, and colleagues described the “unprecedented” case of an infant whose mother was diagnosed with uncontrolled HIV-1 viremia. Although HIV-RNA and DNA were not detected at 3 and 14 days after birth, HIV-DNA was detected when the infant was aged 4 weeks. Controlled ART was initiated at 3 months, when measured HIV-RNA levels had peaked at 2.1x10⁶ copies/mL. HIV-RNA was undetectable after 1 month of treatment and undetectable while on controlled ART, except at 15 and 21 months. Treatment was discontinued by the family when the patient was aged 5.8 years to 6.8 years and was not resumed when HIV-RNA was undetectable at the latter age.

Researchers reevaluated the patient after 10 and 11 years of controlling the virus off therapy. Ultrasensitive HIV-RNA, PBMC-associated HIV-DNA, flow-cytometry-assessed frequency of HIV-specific CD8+ T-cells, CD8+ T-cell-mediated HIV-suppression, and reactivation of the CD4+ T-cell reservoir were all examined at this time.

Fewer than 50 copies/mL of HIV-RNA were detected in the patient through 18.3 years of age —except for a single blip of 515 copies/mL — and CD4+ T-cell counts remained stable throughout. After 11 years of control off therapy, as confirmed by undetectable plasma concentrations of antiretrovirals measured using tandem mass spectrometry, the patient’s HIV-RNA was below 4 copies/mL while HIV-DNA was 2.2 log copies/10⁶ PBMC. Low levels of HIV-RNA and p24 were measured upon activation of CD4+ T-cells with PHA, while HLA genotyping demonstrated homozygosity at multiple loci. HIV-specific CD8+ T-cell response and activation were very weak, and HIV-1 Western blot was positive for the absence of gp110 and p18 antibodies.

“This case provides first-time evidence that very long-term HIV-1 remission is possible in perinatally infected early-treated children, with similar characteristics as reported in adult post-treatment controllers,” the researchers concluded.

Reference:

Frange P, et al. Abstract MOAA0105LB. Presented at: International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2015; Vancouver, British Columbia.

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