Child born with HIV still in remission after 18 months off treatment
Oct. 23, 2013 A 3-year-old Mississippi child born with HIV and treated with a combination of antiviral drugs unusually early continues to do well and remains free of active infection 18 months after all treatment ceased, according to an updated case report published Oct. 23 in the New England Journal of Medicine.
Early findings of the case were presented in March 2013 during a scientific meeting in Atlanta, but the newly published report adds detail and confirms what researchers say is the first documented case of HIV remission in a child.
"Our findings suggest that this child's remission is not a mere fluke but the likely result of aggressive and very early therapy that may have prevented the virus from taking a hold in the child's immune cells," says Deborah Persaud, M.D., lead author of the NEJM report and a virologist and pediatric HIV expert at the Johns Hopkins Children's Center.
Persaud teamed up with immunologist Katherine Luzuriaga, M.D., of the University of Massachusetts Medical School, and pediatrician Hannah Gay, M.D., of the University of Mississippi Medical Center, who identified and treated the baby and continues to see the child.
"We're thrilled that the child remains off medication and has no detectable virus replicating," Gay says. "We've continued to follow the child, obviously, and she continues to do very well. There is no sign of the return of HIV, and we will continue to follow her for the long term."
The child was born to an HIV-infected mother and began combination anti-retroviral treatment 30 hours after birth. A series of tests in the subsequent days and weeks showed progressively diminishing viral presence in the infant's blood, until it reached undetectable levels 29 days after birth. The infant remained on antivirals until 18 months of age, at which point the child was lost to follow-up for a while and, physicians say, stopped treatment. Upon return to care, about 10 months after treatment stopped, the child underwent repeated standard HIV tests, none of which detected virus in the blood, according to the report.
The child's experience, the authors of the report say, provides compelling evidence that HIV-infected infants can achieve viral remission if anti-retroviral therapy begins within hours or days of infection. As a result, a federally funded study set to begin in early 2014 will test the early-treatment method used in the Mississippi case to determine whether the approach could be used in all HIV-infected newborns.
The investigators say the prompt administration of antiviral treatment likely led to the Mississippi child's remission because it halted the formation of hard-to-treat viral reservoirs -- dormant HIV hiding in immune cells that reignites the infection in most patients within mere weeks of stopping drug therapy.
"Prompt antiviral therapy in newborns that begins within hours or days of exposure may help infants clear the virus and achieve long-term remission without the need for lifelong treatment by preventing such viral hideouts from forming in the first place," Persaud says.
Remission, defined in this case not only by absence of infection symptoms but also by lack of replicating virus, may be a stepping stone toward a sterilizing HIV cure -- complete and long-term eradication of all replicating virus from the body. A single case of sterilizing cure has been reported so far, the investigators note. It occurred in an HIV-positive man treated with a bone marrow transplant for leukemia. The bone marrow cells came from a donor with a rare genetic mutation of the white blood cells that renders some people resistant to HIV, a benefit that transferred to the recipient. Such a complex treatment approach, however, HIV experts agree, is neither feasible nor practical for the 33 million people worldwide infected with HIV.
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Child born with HIV still in remission after 18 months off treatment