Children treated in childhood as part of the NIH-funded study and have maintained viral suppression since 2008
A nine-year-old South African child diagnosed with one month old HIV infection and given anti-HIV treatment during childhood has repressed the virus without antiretroviral drugs for eight and a half years, scientists said today on 9 IAS Conference on HIV Science in Paris. This case appears to be the third reported instance of sustained HIV remission in a child after early and limited anti-HIV treatment.
Previously, the "Mississippi Baby," who was born with HIV in 2010, received anti-HIV treatment that began 30 hours after birth, and stopped receiving therapy around 18 months of life, and controlled the virus without medication during 27 months, until unfortunatelyReappearedIn your blood. In 2015, a French child who was born with HIV in 1996, started anti-HIV therapy at the age of 3 months, and discontinued treatment at some point between the ages of 5,5 and 7 years and continued to control the virus without further medications Which 11 years later.
"Further study is needed to learn how to induce long-term HIV remission in infected infants," said Anthony S. Fauci (he is also the author of the Opa text, "A cure for AIDS is not there at the first corner"), , Director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). "However, this new case strengthens our hope that in treating HIV-infected children for a brief period beginning in childhood we can spare them the burden of lifelong therapy and the health consequences of immune activation In the long run typically associated with HIV disease. "
NIAID funded the clinical trial in which the child received follow-up treatment and monitoring and who remained with viral suppression.
The South African child, whose case was reported today, had a confirmed diagnosis of HIV infection in 2007 at 32 days of age, and soon thereafter enrolled in the NIAID-treated children. HIV-infected infants in the trial were randomly assigned to receive early and limited early antiretroviral therapy (ART) or ART during 40 or 96 weeks. The current child was assigned to the 143 group of children who received initial ART for 40 weeks.
Before initiating treatment, the child had very high levels of HIV in the blood (viral load), but after initiating ART at approximately nine weeks of age, treatment suppressed the virus to undetectable levels.
The researchers discontinued treatment after 40 weeks and closely monitored the child's immune health and she remained in good health for years of follow-up exams. Although it was not standard practice in South Africa to monitor viral load in non-ART patients, recent analyzes of stored blood samples taken during follow-up showed that the child maintained an undetectable level of HIV.
When the child was 9 one-and-a-half years old, the researchers conducted thorough laboratory and clinical studies to assess the child's immune health and the presence of HIV. Scientists have detected a reservoir of virus integrated into a small proportion of immune cells, but otherwise found no evidence of HIV infection.
The child had a healthy level of key immune cells, a viral load that was undetectable by standard assays and no symptoms of HIV infection. The researchers detected a trace of immune response to the virus, but found no HIV capable of replicating. The scientists also confirmed that the child has no genetic traits associated with spontaneous HIV control, suggesting that the 40 weeks of ART provided during childhood may have been key to HIV remission.
"To our knowledge, this is the first reported case of sustained HIV control in a child enrolled in a randomized study of ART discontinuation after treatment in early childhood," said Avy Violari, FCPaed.
Dr. Violari co-led the case study reported today, as well as the CHER Study with Mark Cotton, M.Med.
Ph.D. Dr. Violari is head of pediatric research at the Perinatal HIV Research Unit, part of the University of the Witwatersrand in Johannesburg. Dr. Cotton is head of the pediatric infectious diseases division and director of the clinical research unit for infectious family diseases at Stellenbosch University, South Africa.
"We believe there may have been factors other than the initial ART that contributed to the remission of HIV in this child," said Caroline Temessem, Ph.D., whose laboratory is studying the child's immune system. "By further studying the child, we can expand our understanding of how the immune system controls HIV replication." Dr. Temessem is chief of cell biology at the HIV and STI Center of the National Institute of Communicable Diseases (NICD) in Johannesburg.
An ongoing NIH clinical trial calledIMPAACT P1115(Under review) is testing the hypothesis that in treating HIV-infected newborn infants starting at up to 48 hours after birth may allow long-term control of HIV replication after discontinuation of treatment, potentially leading to remission Of HIV. IMPAACT P1115 started at 2014 and enrolled about 400 42-exposed infants, 2017 of them HIV-infected, in Argentina, Brazil, Haiti, Malawi, South Africa, Uganda, the United States, Zambia and Zimbabwe. The first children may become eligible to stop ART at the end of XNUMX.
NIAID provided funding for the CHER trial as part of a comprehensive international research program on granting AIDS-South Africa. Additional support was provided by the Medical Research Council Clinical Trials Unit at University College London, the Western Cape Health Departments and Gauteng in South Africa and ViiV Healthcare.
TheEunice Kennedy ShriverNational Institute of Child Health and Human Development, is also part of the NIH, with continued support of children's observation in CHER after the study ended.
The EPIICAL Consortium funded the recent analysis of viral load in children who participated in CHER. The South African Research Chairs Initiative of the Department of Science and Technology and the National Research Foundation of South Africa funded the laboratory studies of the child whose case was reported today.
Reference: A Violariet al.Viral and host characteristics of a child with perinatal HIV-1 after prolonged period after cessation of ART in the CHER test. 9I IAS Conference on HIV Science, Paris (2017).
Translated by Cláudio Souza from the original inChild Living with HIV Maintains Remission Without Drugs Since 2008
Revised by Mara de Macedo