Four children born with HIV have controlled the virus without treatment for more than a year

The four children are among 54 children who were infected with HIV before birth and were enrolled in a clinical trial funded by the US National Institutes of Health.

Advances in antiretroviral treatment have significantly reduced perinatal transmission of HIV, when a baby becomes infected with HIV in the womb, during childbirth, or by drinking the milk of a breastfeeding person. If transmission occurs, children should receive lifelong ART to control viral replication and protect their immune system from life-threatening complications. Typically, stopping treatment results in a rapid resumption of HIV replication and detection of the virus in the blood within a few weeks.

However, in 2013, a report described a child born with HIV in Mississippi who was started on treatment at 30 hours of age, stopped from ART at 18 months of age, and remained in remission without any evidence of detectable HIV. months.

The study, presented by Deborah Persaud, director of the Eudowood Division of Pediatric Infectious Diseases at Johns Hopkins Children’s Center, was designed to replicate the case of a Mississippi infant believed to be the first recorded case of HIV. remission in a child who was born with the virus and received anti-HIV treatment very early, at 30 hours of age.

Persaud, who was part of the research team that reported the case in 2013 at CROI, said the study results support the idea that ART-free remission is possible with early and effective antiretroviral treatment in newborns.

The researcher noted that standard treatment for infants with HIV usually begins several weeks after birth, often due to delays in testing and results.

Findings from a published study in The Lancet HIV showed that very early initiation of ART in newborns who acquired HIV in utero safely suppressed the amount of HIV in their blood to undetectable levels up to two years of age, while they were still in the womb. .

In the final phase of the study, results of which were presented at CROI this year, four children went into remission, defined as having undetectable HIV for at least 48 weeks without treatment. In one of these babies, the virus returned to detectable levels after 80 weeks. Three children remained in remission at 48, 52 and 64 weeks each.

The other two children in the study did not meet the criteria for HIV remission because each of them became detectable with HIV within three and eight weeks. The two children whose HIV relapsed developed mild acute retroviral syndrome, flu-like symptoms that are often early signs of HIV in adults.

“This is the first time we’ve successfully recreated a Mississippi baby case with four children,” Persaud says. “These findings are an important first step in understanding how to reduce HIV reservoirs. in children to remission without ART and treating more children living with HIV, which will ultimately change the paradigm of treatment for this infection, which currently affects 1.7 million children worldwide.

“These results provide clear evidence that very early treatment allows the unique characteristics of the neonatal immune system to limit the development of the HIV reservoir, increasing the chances of HIV remission,” said NIAID Director Jeanne Marrazzo. “The promising results of this study are a beacon for the future of HIV remission science and highlight the indispensable role of the global network of clinicians and research personnel who conduct pediatric HIV research with the utmost care.”

“ART has changed the paradigm of HIV treatment, but treatment is a long journey, especially for children who are lifelong HIV survivors,” said Adeodata Kekitinwa of Baylor College of Medicine and a registered investigator who leads the Research and Clinical Trials Group in Kampala, Uganda. . “This study brings us one step closer to recognizing yet another paradigm shift in how our approach to ART “It may be so effective that it can be used at one stage of life rather than throughout life.”

According to Persaud, it is too early to talk about treatment for HIV. “We will have to wait at least 10 years before we can confirm this,” he concluded.