A 9-year-old South African child infected with HIV at birth has been in an apparent state of extended viral remission after receiving less than a year of antiretroviral (ARV) treatment for the virus starting at 9 weeks of age.
The child belongs to a rarefied club of three documented individuals born with HIV who have gone into a state of viral remission following a period of ARV treatment begun soon after birth. One of the others, a French teenager, has been in remission for more than a decade. The other, the famous “Mississippi Child,” spent 27 months in such a state before seeing her virus ultimately rebound.
“Further study is needed to learn how to induce long-term HIV remission in infected babies,” says Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID). “However, this new case strengthens our hope that by treating HIV-infected children for a brief period beginning in infancy, we may be able to spare them the burden of lifelong therapy and the health consequences of long-term immune activation typically associated with HIV disease.”
The South African child was a participant in the CHER trial, which included infants who contracted HIV at birth and who were randomized to receive ARV treatment on a deferred basis or to receive ARVs early but only for 40 or 96 weeks. The children were then restarted on ARVs if necessary, based on their CD4 count and other criteria.
Born in 2007, the child was given 40 weeks of HIV treatment, beginning at 9 weeks of age. While on ARVs, the child’s initially high viral load was reduced to an undetectable level and apparently has remained so since.
At 9 ½ years old, the child had a robustly healthy CD4 count and no symptoms of HIV infection. A battery of highly sensitive tests found only a very small viral reservoir but otherwise no signs of infection, including no virus capable of copying itself.