After very early antiretroviral therapy during infancy, an HIV-positive child in South Africa has been able to control the virus without any meds for eight and a half years, according to a study presented at IAS 2017.
The child appears to be just the third case of sustained HIV remission after very early treatment in an infant. The first reported case was the "Mississippi Baby," who was treated within 30 hours after birth and, after stopping treatment at 18 months, appeared to be cured until the virus suddenly rebounded 27 months later.
The second reported case was a French girl who was born with HIV, started antiretroviral therapy at age three months and stopped treatment about five and a half years later. Despite stopping treatment, the girl was able to maintain an undetectable viral load for over 12 years as of 2015, with no reports that her virus has rebounded.
The South African child in this new study was diagnosed at 32 days of age in 2007, and was then enrolled in the Children With HIV Early Antiretroviral Therapy (CHER) trial, a study examining treatment interruption in infants living with HIV. The child was randomized to receive limited antiretroviral therapy for 40 weeks. After starting with a very high viral load and beginning treatment at around 63 days of age, the child quickly achieved an undetectable viral load.
After completing 40 weeks of antiretroviral therapy, treatment was interrupted and the researchers closely monitored the child's health. To their surprise, the child continued to have an undetectable viral load and has maintained undetectable levels for eight and a half years.
When the child was nine and a half years old, the researchers ran tests to assess the child's HIV status, detecting a small reservoir of virus in a proportion of immune cells, but no other evidence of HIV. The researchers also detected a trace of immune response to HIV, but no virus actually capable of replicating. They ran tests to confirm that the child was not an elite controller, meaning the child did not possess special genetic characteristics that enable control of HIV without meds. This led the researchers to believe that the 40 weeks of treatment during infancy were key to achieving this HIV remission.
"To our knowledge, this is the first reported case of sustained control of HIV in a child enrolled in a randomized trial of [antiretroviral therapy] interruption following treatment early in infancy," said co-lead study author Avy Violari, FC Paed, according to the study press release.
"We believe there may have been other factors in addition to early ART that contributed to HIV remission in this child," said Caroline Tiemessen, Ph.D., who leads the laboratory analyzing the child's immune system, according to the study press release. "By further studying the child, we may expand our understanding of how the immune system controls HIV replication," Tiemessen added.
"It's another example, in my opinion, of the spectrum that we will continue to be seeing as we study more and more people, not only children but also even adults who get treated very early in the course of their infection," Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), told TheBody.com.
"In many respects, nothing is new -- because we've seen this before. That person [the South African child] may go indefinitely or that person may rebound next year for all we know," Fauci added.
When asked how we could translate this into adults living with HIV, Fauci addressed what he thought may be the common denominator: "You have to start off with a relatively small reservoir that may take a long time to regenerate and/or have some immune function that's able to suppress the reservoir from rebounding."
"We're going to see -- depending upon factors that still we don't fully understand -- that when you suppress virus very early, you're going to have a range of time from when the person stops therapy to the time they rebound. And the range is going to be very wide for sure," Fauci said, noting that it could be almost immediately, within a few months or years.