Child Maintains HIV Remission Without ART Since 2008

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The IMPAACT P1115 trial is evaluating whether ART initiation in HIV-infected newborns within 48 hours of birth allows for long-term control of HIV replication after treatment ends.
The IMPAACT P1115 trial is evaluating whether ART initiation in HIV-infected newborns within 48 hours of birth allows for long-term control of HIV replication after treatment ends.

A 9-year-old South African child who was diagnosed with HIV at 1 month and received early treatment has suppressed the virus without anti-HIV therapy for 8.5 years, according to a case report presented at the 9th IAS Conference on HIV Science in Paris, France.1,2

The child was diagnosed with HIV in 2007 at 32 days old and was enrolled in the CHER (Children with HIV Early Antiretroviral Therapy) clinical trial where the child was randomized to receive early, limited antiretroviral therapy (ART) for 40 weeks. Compared to the child's high viral load at baseline, ART suppressed the virus to undetectable levels at about 9 weeks. The treatment was stopped after 40 weeks and the child was closely monitored. During the years of follow-up, the child had maintained good health as well as an undetectable level of HIV. 

At age 9 and a half, researchers performed lab and clinical assessments to evaluate the child's immune health and presence of HIV. A reservoir of virus incorporated in a small proportion of immune cells was observed but no signs of HIV infection were noted. The child exhibited a healthy level of immune cells, an undetectable viral load, and no symptoms of HIV. Investigators noted a slight immune response to the virus but did not find HIV with replicating abilities. Furthermore, the child was not found to have genetic characteristics tied to spontaneous control of HIV, which led the scientists to believe 40 weeks of ART during infancy "may have been key to achieving HIV remission." 

This case marks the third report of sustained HIV remission in a child after receiving early anti-HIV treatment. In 2010, the "Mississippi Baby", born with HIV, received treatment starting 30 hours post-birth, discontinued therapy around 18 months old, and was able to control the infection without anti-HIV therapy for 27 months before it reappeared. In 2015, a French baby was born with HIV, received treatment at 3 months, discontinued treatment at some point between 5.5-7 years, and was able to control the infection without anti-HIV therapy for >11 years. 

Avy Violari, FCPaed, co-author of the case, stated, “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."

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), added, "... 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.”

Currently, the IMPAACT P1115 trial is evaluating whether ART initiation in HIV-infected newborns within 48 hours of birth allows for long-term control of HIV replication after treatment is discontinued. The trial, which started in 2014, has enrolled nearly 400 HIV-exposed infants

References

  1. Child living with HIV maintains remission without drugs since 2008 [press release]. Bethseda, Maryland: National Institutes of Health. Published July 24, 2017. Accessed August 9, 2017.
  2. Violari A, Cotton M, Kuhn L, 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 2017; July 23-26, 2017; Paris, France; Poster TUPDB0106LB.
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