A child with intrauterine-acquired HIV who received antiretroviral therapy (ART) at 33 hours after birth through age 13 months showed persistent undetectable HIV viremia more than 3 years after discontinuing ART, according to research presented at the virtual Conference on Retroviruses and Opportunistic Infections (CROI), held between March 8 and 11, 2020.
The infant was born to a mother with no prenatal care and a 6-year history of diagnosed but untreated HIV infection, who demonstrated 14,400 HIV RNA copies/mL and 27% CD4 at delivery. The child was started on ART with zidovudine, lamivudine, and nevirapine 33 hours after birth. Evaluation of blood samples taken on the first and second day of the child’s life failed due to technical issues. A day 14 sample tested positive for HIV DNA. Following this positive test, dried blood spots from first day of life routine newborn screening were tested for HIV DNA with a positive result. At day 16 of life, ART was switched to lopinavir/ritonavir, lamivudine, and zidovudine. After 13 months of ART, the mother discontinued her child’s treatment.
The child remained clinically well without opportunistic infections and demonstrated an undetectable HIV RNA (<20 copies/mL) from birth through age 4 years, and HIV-specific antibodies became and remained negative from age 15 months onward. Testing by HIV droplet digital polymerase chain reaction-DNA was performed at intervals beginning at day 114 of life and were intermittently detected, with the most recent showing <1 copy of gag and pol DNA/ million CD4 cells.
Because the cases of few children with this pattern have been reported, it is unclear how rarely this occurs, noted the investigators. “The capacity of these children to control HIV viremia for extended intervals in the absence of ART raises questions of whether HIV viremia control results from viral competence, host immunity, host genetics, or some combination,” they concluded.
Heresi GP, Richman DD, Hammoud RA, Rodriguez G, Perez N, Murphy JR. Sustained remission in a 4 year old HIV infected child treated the first year of life. Poster presented at: CROI 2020; March 8-11, 2020; http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 17, 2020.