A nine-year-old child in South Africa may be the third case of a child in remission after antiretroviral therapy against HIV only during childhood.
The case was reported by physicians from the Perinatal Research Unit on HIV at the Faculty of Health Sciences, University of Witwatersrand, July 15 at the International AIDS Society Conference in Paris.
The child was part of a trial called early antiretroviral treatment of children with HIV carried out by the medical team. In the study, children with HIV infection were randomly assigned to receive one of three treatments – a delayed antiretroviral therapy or a limited early antiretroviral therapy for 40 or 96 weeks.
The child was born to a mother infected with HIV in 2007 and was diagnosed as HIV positive with very high viral loads in just 32 days. In about nine weeks, the child received antiretroviral treatment that suppressed the virus to undetectable levels.
According to the protocols of the randomized trial, the investigators discontinued treatment after 40 weeks. They monitor the child’s immunity and saw that the child remained healthy for years of follow-up exams.
Recent analyzes of blood samples stored in the sample during the child’s follow-up tests show that the child has maintained undetectable HIV-1 levels because his treatment was stopped when he was a child. The researchers detected a viral reservoir that was built on a small proportion of cells in the child’s immune system, but has yet to find evidence of HIV infection.
The child had healthy levels of key immune cells, the viral load was undetectable by the laboratory’s routine diagnostic tests, there were no symptoms of HIV infection and no replication of the competent virus.
The child has no genetic characteristics previously associated with spontaneous adult HIV control, suggesting that the 40-week antiretroviral therapy provided during infancy may be essential for HIV-1 remission in this case.
“We believe there could be other factors besides the early arts that contributed to the remission of HIV in this child,” said Professor Caroline Tiemessen, lead author of this case and master virology research at the School of Pathology at the University of Wits.
The researchers called for further research into the mechanisms of the child’s immune system to expand understanding of how they control HIV replication.