First child 'cured' of HIV remains in remission for 18 months

[J.R.E.]

http://www.medicalnewstoday.com/articles/267892.php

 Researchers have revealed that a 3-year-old girl from Mississippi who was born with HIV continues to be in remission 18 months after her combination antiretroviral treatment was stopped. This is according to an updated case report published in The New England Journal of Medicine.

Medical News Today reported on the early findings of this case in March this year, in which the researchers said was the first case of a "functional cure" in an HIV (human immunodeficiency virus) positive infant.

But the research team from the Johns Hopkins Children's Center, the University of Massachusetts Medical School and the University of Mississippi Medical Center, say this confirmation of their findings suggest that the child's remission is "not a mere fluke."

They add that the findings provide "compelling evidence" that if an HIV positive child is started on antiretroviral therapy within the first hours or days of infection, viral remission can be achieved.
Child showed 'no detectable HIV 29 days after birth'

Born to an HIV-infected mother, the child began aggressive antiretroviral therapy (ART) 30 hours after birth.

Through a series of blood tests carried out days and weeks after treatment first began, the child demonstrated rapidly diminishing levels of the virus in her blood. When tested 29 days after birth, there were no detectable traces of the viral infection.

The child received antiviral treatment until she was 18-months-old, after which point the treatment was stopped. After undergoing standard repeat HIV tests around 10 months after the ceasing of treatment, the report states that physicians detected no HIV in her blood.
Therapy 'must start early' in HIV-infected Infants

The researchers believe that through beginning the child's treatment so early, ART was able to halt the formation of hard-to-treat viral reservoirs. These are defined as immune cells with "dormant" HIV that can reignite the infection within weeks of ceasing therapy.

However, the researchers emphasize the fact that treatment in HIV-infected infants must begin very early on following infection.

They point to recent studies showing that many hard-to-eradicate viral reservoirs form in the first few weeks of an infant's life. Studies have also shown that infants with HIV show a "marked reduction" in the numbers of circulating virus-infected cells if they are treated within the first few weeks after infection.

Therefore, these findings suggest there is a small window in which a child's remission from HIV may be achieved.

Katherine Luzuriaga of the University of Massachusetts Medical School and senior author of the study, explains:

    "This case highlights the potential of prompt therapy to lead to long-term remission in those already infected by blocking the formation of the very viral reservoirs responsible for rekindling infection once treatment ceases.

    This may be particularly true in infants, whose developing immune systems may be less amenable to the formation of long-lived virus-infected immune cells."

A step towards an HIV cure

To date, the child's tests for HIV-specific antibodies and tests that detect for the presence of "killer" cells - which indicate active infection - remain negative.

However, ultrasensitive tests that are able to detect traces of the virus did find the presence of "viral footprints." But the researchers say this is a type of "leftover" HIV that seems to be unable to form new virus, meaning the infection is unlikely to reignite.

"We're thrilled that the child remains off medication and has no detectable virus replicating," says Hannah Gay, pediatrician at the University of Mississippi Medical Center. "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 researchers explain that because the child in this case has demonstrated absence of infection symptoms as well as lack of replicating virus, this could lead to a "sterilizing" HIV cure - a cure that has the ability to abolish all replicating virus from the body long-term.

According to the World Health Organization (WHO), at the end of 2011 there were estimated to be 3.4 million children living with HIV worldwide, with 91% of these living in sub-Saharan Africa.

WHO state that the majority of these children acquire HIV from their HIV-infected mothers during pregnancy, highlighting the need for newborn HIV treatment.

As a result of the 3-year-old's remission, a new study is set to begin early next year that will test the early antiretroviral therapy approach in order to determine whether this is a strategy that could be used for all newborns infected with HIV.