“This is really very rare,” said Dr. Avy Violari, head of pediatric clinical trials at the Perinatal HIV Research Unit at the University of Witwatersrand in South Africa. Violari is the child’s doctor and presented the findings at the
9th International AIDS conference on HIV Science in Paris on Monday. “By studying these cases, we hope we will understand how one can stop (treatment),” Violari said.
The child, who was not identified, was part of a study known as the Children with HIV Early Antiretroviral Therapy, or CHER, trial, which ran from 2005 to 2011. More than 370 infants infected with HIV were randomly assigned to immediately receive ART for either 40 weeks or 96 weeks. A third group were not placed on immediate treatment, but instead received treatment according to standard guidelines at the time.
When the trial began, standard treatment was based on the level of immune cells damaged by the virus, known as CD4 cells, within the body. Current guidelines recommend immediate treatment, irrespective of CD4 cell count.
In infants infected with HIV close to birth, progression of the disease occurs very rapidly within the first few months of life and can often lead to death, according to the
World Health Organization. An estimated 110,000 children died of AIDS-related illnesses in 2015, according to
UNAIDS.
Pediatricians also worry about the side-effects and health impacts of lifelong treatment with antiretroviral drugs for those who survive.
More than 1.8 million children were living with HIV in 2015, according to UNAIDS, and 150,000 children became newly infected, the majority of which were in Africa.
The study found mortality decreased by 76% and HIV disease progression reduced by 75% among the infants who received treatment immediately, for 40 or 96 weeks. The group receiving standard treatment saw an increase in mortality based on interim results, so that arm of the trial was stopped early.
Children receiving early treatment in the trial needed to go back onto it, on average, after two years, Violari said, with cases ranging from needing it immediately to needing it after four years. An estimated 10 children have not had to go back on treatment, she said, as their viral loads are fairly low — between 1,000 to 3,000 per milliliter of blood — meaning they are healthy, in clinical terms.
But virus levels in the 9-year-old case are undetectable. “The child is the only child showing remission,” said Violari. “We cannot see virus in the blood using standard techniques … we can see fragments of the virus in the cells,” she said, adding that these fragments appear not to be able to replicate, for now, giving hope the child may stay this way. “This child is unique.”
The Three Cases:
The South African child is the third reported case of long-term HIV remission in a child after early, limited treatment with antiretroviral drugs.
The first case was a Mississippi baby, a girl born in 2010, who received ART just 30 hours after birth until she was 18 months old, at which point HIV remission was achieved. The baby sustained remission for 27 months, until 2015, when she rebounded and the virus was found in her blood.
The second is a a French teenager, now 20, whose mother was HIV positive. The French child was given antiretroviral treatment soon after birth, stopped treatment at age 6 and has maintained undetectable levels of the virus in her blood since.
