The nine-year-old child is the subject of one of the only cases of HIV remission to ever have been reported.
An HIV-infected child who received a short course of treatment early in life has been in remission for more than eight years. The encouraging case is the third of its kind reported globally and the first one to be reported in Africa.
The South African child was diagnosed with HIV at the age of one month. Soon after the diagnosis, antiretroviral therapy (ART) was administered to the child for about 40 weeks after which the therapy was ended. The health of the child was then closely watched over the years. Near the end of 2015, blood tests revealed that the child is in remission from HIV. Results of past tests conducted on the child also revealed that remission had been entered post-treatment.
The child who is now 9-years-old was one of the subjects of a new clinical trial named “Children with HIV Early Antiretroviral Therapy” or CHER. The trial was conducted between 2005 and 2011. The study aimed to investigate whether early treatment of HIV-infected infants could help reduce mortality rates and allow children to be kept away from treatments for periods of time.
The trial divided the patients into three randomly selected groups. Two groups received immediate ART for either 96 weeks or 40 weeks. The third group received treatment as per the standard guidelines of the time.
The study revealed that infants administered immediate treatment for 40 or 96 weeks exhibited a 76% decrease in mortality and a 75% reduction in disease progression. The mortality of patients receiving the standard treatment increased leading to an early halt in that arm of the trial.
Prior to this case, only two other cases of long-term HIV remission after short-term ART in early life have been reported. The first case was that of a 2010-born Mississippi baby who received ART starting from 30 hours after birth to the age of 18 months. Although remission was detected at the end of the treatment, the baby rebounded in 2015, and the virus was once more detected in her blood. This ended all hopes that a “functional cure” of HIV could be achieved using this approach. The second case was that of a 20-year-old French teenager who received antiretroviral treatment beginning at birth and lasting until the age of 6. Since then, the girl has maintained such low levels of HIV in her blood that it is essentially undetectable.
In the case of the South African 9-year-old, the remission for over eight years has been achieved with just 40 weeks of treatment.
Head of the Perinatal HIV Research Unit at South Africa’s University of Witwatersrand, Dr. Avy Violari tells CNN, "This is really very rare.” She also says: "This child is unique.” Something about the immune system and biology of the child helped protect him from HIV and that was aided by an early treatment regime.
In the past, only three HIV-infected adults have ever been reported as "in remission". The transplant of bone marrow was the reason behind all of these transplants. Only one of these adults, Timothy Ray Brown, also known as the Berlin patient, was clinically cured of HIV.
The director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, tells CNN that the case of the 9-year-old child testifies the fact that it could be possible to achieve long-term remission in some babies using the CHER approach. His institute funded the CHER trial and the follow-up studies of the patients involved in the trial.
Fauci also believes that the success of such trials only become important when a large percentage of infants exhibit long-term remission. "You always get an outlier," he said. In this case, the 9-year old is an outlier."
According to WHO, the progression of diseases is very rapid in HIV-infected infants and often leads to death. UNAIDS reports that in 2015, an estimated 110,000 children died of AIDS-related illnesses. In the same year, over 1.8 million children were surviving with HIV. Pediatricians worry that long-term treatment with antiretroviral drugs will subject the child to side effects and potential toxicity associated with the drugs. Also, the need to adhere to a strict daily treatment regime might become harder to maintain during the teen years.
The success of the case of the 9-year-old child gives hope to cure researchers of HIV and those managing clinical trials for children. The discovery becomes useful in terms of treating infants with HIV.
- By Oishimaya Sen Nag