Boys may have easier time controlling HIV than girls, study findings suggest
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Key takeaways:
- Five male infants in South Africa maintained viral suppression for months despite nonadherence to ART.
- No such cases occurred among female infants, suggesting boys may have a better chance of controlling HIV.
Five male infants in South Africa who were born with HIV were able to maintain undetectable viral loads for months despite low adherence to ART, according to researchers at the International AIDS Society Conference on HIV Science.
No such cases occurred among female infants, who made up 60% of the study population, suggesting that boys may have a better chance at controlling HIV because of innate immune differences in the sexes, researchers said.
“Reports of children who have been able to achieve post-treatment HIV control after having started early combination ART — such as the Mississippi baby case — generated the hypothesis that early cART initiation could facilitate functional cure in a subset of children,” Gabriela Cromhout, MD, a postgraduate student at the University of KwaZulu Natal in South Africa, said during a press conference.
“We started this research with the hopes to potentially cure children through very early cART initiation,” she told Healio.
Cromhout and colleagues studied 281 mother-child pairs following in utero HIV transmission to determine whether children who are treated very early on can achieve post-treatment control of HIV without additional interventions, and if so, what mechanisms might contribute to that control. All children in the study received ART at birth, and 92% had received ART before birth through their mothers.
“The fact that the study is prospective is key because this enables us to collect all the critical samples at birth and in the first few days of life from mother-child pairs which are not available later,” Cromhout told Healio. “These samples are critical to demonstrating that HIV vertical transmission has occurred and to understanding post-treatment control should it occur later.”
Of the cohort, five male infants maintained viral suppression from more than 3 months to more than 19 months despite poor adherence to ART. Ultimately, they found that maintenance of viral control was highly dependent on adherence to ART, irrespective of infant baseline plasma viral load.
The researchers also found that females had higher rates of in utero transmission, which was associated with their robust type 1 interferon response, part of the innate immune response, Cromhout noted.
"HIV transmitted to males is more type 1 interferon sensitive whereas the viruses transmitted to females tend to be type 1 interferon resistant," Cromhout said.
“The results greatly surprised our team,” Cromhout told Healio. “Firstly, we were surprised by the unequivocal evidence that some children could maintain aviraemia without taking therapy. Due to social reasons, several mothers/caregivers stopped giving therapy altogether and the majority of these children rebounded because of this. However, these five cases were aviraemic despite nonadherence to cART.”
“The other major surprise,” Cromhout continued, “was the impact of sex differences that were identified, ie, that females appear to be more susceptible to acquiring HIV in general and that males are more likely to be post-treatment controllers.”
“We would like to see trials of T-cell vaccines and broadly neutralizing antibodies in children who have been initiated on cART very early, who therefore have very low viral reservoirs,” Cromhout said.
[Editor's note: This story was updated to clarify that the sensitivity differences of HIV transmitted to males vs. females is associated with type 1 interferon and not sensitivity or resistance to ART.]
References:
Among children born with HIV, boys may have a better chance of sustained remission due to innate immune sex differences. https://www.iasociety.org/news-release/ias-2023-highlights-advances-in-hiv-prevention-treatment-and-cure-research. Published July 19, 2023. Accessed July 20, 2023.
Cromhout G, et al. Abstract 5727. Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
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Cromhout G, et al. Abstract 5727. Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
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