At the recent conference of the International Aids Society in Paris it was a topic hotly discussed by academics, researchers and representatives of NGO’s:
A 9-year-old South African child diagnosed with HIV when he was 1 month old has been in HIV remission for 8½ years — without regular treatment. This is the first reported case of a child controlling their HIV infection without drugs in Africa and the third known case globally. The related research was conducted among others by Prof Dr Mark Cotton, board member of our HOPE Cape Town Association.
Soon after diagnosis, the child was placed on antiretroviral treatment, or ART, for 40 weeks, at which point treatment was stopped and the child’s health was monitored. Blood tests in late 2015 revealed the child is in HIV remission, meaning levels of the virus in the blood are undetectable using standard tests. Subsequent testing of samples dating back to the child’s infancy confirm remission was achieved soon after treatment was stopped. Treatment was paused as part of a larger research trial investigating the potential for early ART to decrease infant mortality and cut the need for lifelong treatment among newborns infected with HIV. “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 Society Conference on HIV Science in Paris
The child, not identified, was part of a study known as the Children with HIV Early Anti-retroviral Therapy, or CHER, trial, conducted in the years 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 received no immediate treatment, but instead was looked after according to standard guidelines at the time. The CHER trial set out to investigate whether mortality rates could be reduced, but also whether earlier treatment could keep children healthy enough to enable them to come off treatment for certain periods. “We were hoping to make it a slower-progressing disease,” said Violari.
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. But virus levels in the 9-year-old case remained and remain undetectable. “The child is the only child showing remission,” said Violari. “We cannot see virus in the blood … 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.
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, crushing hopes that this approach could be the route to a “functional cure” for HIV. Next came the 2015 case of 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.
“We are delighted and excited by what happened with this child … we need to extrapolate from this to the benefit of other children on antiretroviral drugs,” said Prof Mark Cotton, Professor of Pediatrics at Stellenbosch University in South Africa, who co-led the study. “Africa is still the epicenter of the epidemic and more babies are acquiring HIV than anywhere else.”
Cotton hopes his team presenting these results will boost morale, both among cure researchers and those managing treatment programs for children across the continent.
More links:
Hope for future HIV cure revived
It is really very rare
Without drugs
Filed under: Africa, HIV and AIDS, HIV Treatment, HOPE Cape Town Association, HOPE Cape Town Association & Trust, Medical and Research, South Africa, Aids, cape town, CHER, Cotton, cure, French teenager, hiv, HOPE Cape Town Association, IAS, Mississippi Baby, paris, remission, research, treatment HAART, trial, Violari
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