First case of prolonged remission in HIV-infected child reported

21 Jul

Doctors have found that an 18-year-old woman infected with HIV at birth via mother-to-child transmission has been in remission despite not receiving any antiretroviral therapy for the past 12 years.

HIV cells.
The patient had an undetectable viral load during the 12 years she did not receive antiretroviral therapy.

Researchers from the HIV, Inflammation and Persistence Unit at the Institut Pasteur in Paris believe that the patient has benefited from treatment initiated shortly after birth and ended 6 years later.

The case will be presented at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada, by Dr. Asier Sáez-Cirión.

“Our work has demonstrated for the first time that long-term remission from HIV infection can be achieved in a child infected during the perinatal period, following discontinuation of effective antiretroviral therapy begun very early on, during the first few months of life,” reports Dr. Sáez-Cirión.

The patient in question was born in 1996 and infected with HIV either at the end of pregnancy or childbirth. Despite a 6-week course of the antiretroviral drug zidovudine, she was diagnosed as HIV-positive 1 month after birth.

Two months later, doctors found that the patient had a very high quantity of the virus in her blood, prompting them to initiate a course of treatment involving four antiretroviral drugs. This treatment continued until she was lost to follow-up at the age of 6, at which point her parents stopped the therapy.

However, one year later, the patient was assessed by a medical team who found that her viral load was undetectable. Her doctors chose not to resume antiretroviral therapy, and to date her viral load is still undetectable. Her CD4 cell count has also remained consistent, indicating that her HIV is stable.

“This girl has none of the genetic factors known to be associated with natural control of infection,” states Dr. Sáez-Cirión. “Most likely she has been in virological remission for so long because she received a combination of antiretrovirals very soon after infection.”

Case supports immediate antiretroviral therapy for babies born with HIV

The case is similar on many levels to the adult patients of the ANRS VISCONTI study – a cohort of 20 patients who received antiretroviral therapy in the first few months after HIV infection. After an average of 3 years of therapy, these patients demonstrated control of the virus for an average of 10 years without further treatment.

Dr. Sáez-Cirión explains that both the adult patients of the ANRS VISCONTI cohort and the young girl received a standard level of treatment; the only distinguishing factor in these cases is that treatment was initiated very soon after HIV infection occurred.

Although this case indicates that long-term remission is possible in children as well as adults, Dr. Sáez-Cirión cautions that such cases are still rare.

He refers to the case of the “Mississippi baby” – the only previous known case of HIV remission in a child that was at the time heralded as evidence of HIV being cured. Unfortunately, the child was found to have the disease again 27 months after antiretroviral therapy was stopped.

Prof. Jean-François Delfraissy, director of ANRS (France’s National Agency for Research on AIDS), states that the patient’s remission should not be equated with a cure:

“This young woman is still infected by HIV and it is impossible to predict how her state of health will change over time. Her case though constitutes a strong additional argument in favor of initiation of antiretroviral therapy as soon as possible after birth in all children born to seropositive mothers.”

At present, the team are unable to predict which patients will benefit from a remission following the discontinuation of antiretroviral therapy. “For this reason,” Dr. Sáez-Cirión concludes, “discontinuation of antiretroviral treatment is not recommended, either in adults or in children, outside clinical trials.”

Previously, Medical News Today reported on a study suggesting that HIV cells only “wake up” once a week following antiretroviral therapy.

Written by James McIntosh

Copyright: Medical News Today