South African HIV-positive child medication-free for almost nine years
A South African HIV-positive child has been without antiretroviral treatment for almost nine years and is healthy‚ with only trace amounts of the virus in their body.
This was announced on Monday morning at the International Aids Society conference in Paris.
The child‚ whose gender has not been revealed‚ was part of a US National Institutes of Health-funded study and the South African part of the trial was headed by Dr Avy Violari‚ head of paediatric research at the Perinatal HIV Research Unit at Wits University.
Violari told TimesLIVE it was “very exciting” to be part of the research.
In 2008‚ the baby was diagnosed as HIV-positive at 32 days old and put on antiretroviral treatment about 9 weeks after birth.
Then the child was taken off treatment at 40 weeks old‚ along with 125 babies in the international study on the early treatment of babies.
The child has not required medication ever since.
Before treatment at 9 weeks old‚ the child had high levels of HIV in the blood.
Now the virus is not replicating and researchers can only find trace amounts of the virus in the immune system and a tiny immune response to HIV.
“To our knowledge‚ this is the first reported case of sustained control of HIV in a child enrolled in a randomized trial of anti-retroviral treatment interruption following treatment early in infancy‚” said Violari.
A child known as “the Mississippi baby” started treatment 48 hours after birth and the mother stopped her treatment at 18 months. The child managed without treatment for 27 months.
Researchers hope by putting HIV-positive babies on treatment as soon as possible‚ some may be able to stop treatment for a period of time.
“Further study is needed to learn how to induce long-term HIV remission in infected babies‚” said Anthony Fauci‚ director of the National Institute of Allergy and Infectious Diseases‚ part of the National Institutes of Health.
He said there would be a spectrum of children who would be in remission for different periods of time.
Fauci added: “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 life-long therapy and the health consequences of long-term immune activation typically associated with HIV disease.”
Fauci said it strengthened the argument that babies born positive must be put on treatment as soon as possible as it stopped the virus entering too many cells.
Mother-to-child preventative treatment has reduced the rate of South African children born HIV-positive to less than 2% of all babies born to HIV-positive mothers.
“Infants in South Africa do get treatment earlier since birth testing has been introduced in the public sector. Therefore infant antiretroviral treatment can be started within weeks of birth‚” Violari said.
“Remission is rare but even if these children don't achieve remission‚ starting ARVs earlier improves their health significantly.”
The unique child is being studied to teach scientists more about controlling HIV‚ Violari said.
“By studying the immune response of these cases we can learn more about the immune system and what is important for viral control in addition to antiretroviral therapy.”
The child does not have rare genetic characteristics associated with controlling the virus.
Dr Caroline Tiemessen‚ head of cell biology at the National Institute of Communicable Diseases (NICD) in Johannesburg‚ is studying the child's immune system.
“We believe there may have been other factors in addition to early treatment that contributed to HIV remission in this child‚” said Tiemessen.
“By further studying the child‚ we may expand our understanding of how the immune system controls HIV replication.”
The child is being closely monitored.
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