A South African child, believed to have been infected with HIV around the time of birth, has remained free of the virus for 8 1/2 years without regular treatment — renewing hope among scientists that such outliers may hold clues to help end the decades-old epidemic.
This is the first reported case of a child controlling their HIV infection without drugs in Africa and the third known case globally.
The case study, described by researchers before a presentation Monday at aninternational AIDS conference in Paris, suggests a paradigm shift in the treatment of those infected. It establishes that HIV may be controllable in some way other than a daily and life-long regimen of antiretroviral drugs.
At the conference, researchers presented the results on the child who was diagnosed with HIV in 2007—32 days after birth—and enrolled in a clinical trial. In the trial, infants diagnosed with the virus were randomly assigned to either receive delayed antiretroviral therapy (ART) or to be given early ART treatment for 40 or 96 weeks, at which point it would be stopped. The South African child is among 143 infants who received ART for 40 weeks.
The child whose identity is being protected had very high levels of HIV in the blood before starting treatment when it was about nine weeks old. With treatment, levels of the virus dropped to a point where they were no longer detectable. After 40 weeks of treatment, researchers stopped the therapy and tracked the child closely. So far, the child has maintained nearly undetectable levels of the virus. Scientists were able to detect a small supply of virus in a very small portion of immune cells, but so far they have not found evidence of an HIV infection, and the child has shown no symptoms of the disease.
“To our knowledge, this is the first reported case of sustained control of HIV in a child enrolled in a randomised trial of ART interruption following treatment early in infancy,” said study author Avy Violari, head of paediatric research at the Perinatal HIV Research Unit, in a statement.
The study authors believe that other factors may be contributing to why the South African child’s immune system has been so successful at keeping HIV levels down, and they plan to keep following the child and study its immune system.
Currently, doctors and scientists start children with HIV on ART and do not stop the treatment. According to Violari, the child in the new case study partook in the trial 10 years ago when treatment guidelines for children were different.
“Although the medications have risks, the benefits far outweigh the risks. At this stage, we don’t recommend any child stops treatment,” Violari said.
The child is the third to reach long term remission with no drugs. In 2010, a child referred to as the “Mississippi Baby” was born with HIV and began treatment just 30 hours after birth. The treatment was stopped when the child reached around 18 months. After a couple years, however, the virus reappeared and the child was put back on ART.
In 2015, scientists reported another case in a French child. According to the case study, a French baby was born with HIV in 1996 and received treatment when it was three months old. The child stopped treatment a few years later and has continued to control the virus without drugs.
Worldwide, 36.7 million people are living with HIV and only 53% of them are receiving antiretroviral therapy.
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