An 18-year-old HIV-infected girl during her mother’s pregnancy is in remission, after having been on antiretroviral therapy until she was six years old, after which treatment was stopped, according to a study published Monday.
This first global case shows that “prolonged remission after early treatment can be obtained in a child infected with HIV since birth,” according to the French study presented by Dr. Asier Sáez-Cirión of the Pasteur Institute, the 8th HIV Pathogenesis Conference, which runs until Wednesday in Vancouver.
The concept of long-term remission after antiretroviral therapy, highlighting the importance of early treatment to control HIV infection, had already been highlighted by the ANRS Visconti study published in 2013.
The observation presented Monday was made on a child born in 1996 “infected in late pregnancy or childbirth while his mother had a viral load (amount of virus in the blood) uncontrolled.”
The child was immediately treated with the antiretroviral drug Zidovudine for six weeks and diagnosed with HIV “one month after birth”, according to the work carried out by the Pasteur Institute, Inserm and the Public Assistance of Hospitals of Paris (AP-HP).
“Two months later, following the planned discontinuation of prophylaxis, she had a very high viral load, leading to four antiretrovirals being started for the first six years of her life,” she said. Dr. Sáez-Cirión.
The child was later “lost to sight” by the medical profession and “his family decided to stop taking antiretrovirals”.
“Review a year later” by the medical team, the little girl “had an undetectable viral load (less than 50 copies of HIV-RNA per ml of blood)” and it was then decided “not to resume the treatment, “noted the study.
A French woman, carrying HIV since birth, is in remission:
Still infected with HIV
Now a little over 18 years old, this young woman “still has an undetectable viral load (…) without having ever taken antiretrovirals”.
“Its number of lymphocytes (cells responsible for immune memory against diseases, Ed) CD4 has remained stable throughout these years,” noted the scientists.
The young woman “has none of the genetic factors known to be associated with a natural control of the infection,” said Dr. Asier Sáez-Cirión, ensuring that “it is the fact of having received very soon after its contamination. a combination of antiretrovirals that has allowed her to be in virologic remission for so long. “
The study provides “proof of the concept that long-term remission is, as in adults, possible in children”. Dr. Sáez-Cirión, however, recommends not to stop antiretroviral therapy outside of clinical trials, whether in children or adults.
It bases its recommendation on the case of an HIV-infected infant in the United States who was treated early, “whose remission was only 27 months after stopping antiretroviral therapy.”
If the case of the young woman “is a major clinical fact that opens new perspectives of research”, it is however to emphasize that “this remission should not be assimilated to a cure,” said Professor Jean-François Delfraissy , director of the ANRS, a group of researchers from all disciplines on AIDS and viral hepatitis.
“This young woman remains infected with HIV and it is impossible to predict the evolution of her health status,” he added. However, this case makes it possible to advocate “for antiretroviral treatment of all children born to HIV-positive mothers as soon as possible after birth”.