March 20, 2024

In The News: Children Surpass a Year of HIV Remission After Treatment Pause

Medical Xpress reports on a presentation of a clinical trial in children who acquired HIV before birth delivered at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI). Following an ART regimen administered within 48 hours of birth and monitored for drug safety and suppression, four children were found to be free of detectable virus for more than a year after their therapy was paused. The director of the National Institute of Allergy and Infectious Diseases heralded the study outcome as “a beacon for future HIV remission science” while lauding the global network of pediatric HIV researchers and clinicians.

A 2013 case report described an infant born with HIV who had treatment initiated at 30 hours of life. When later taken off ART at 18 months, the infant remained in remission with no detectable HIV for 27 months. Prior publications on the case report showed ART initiated within hours of birth was safe and effective in achieving and maintaining HIV suppression. Those findings served as a foundation for researchers in Brazil, Haiti, Kenya, Malawi, South Africa, Tanzania, Thailand, Uganda, the United States, Zambia, and Zimbabwe to begin early-stage proof-of-concept study.

The experiences of six children, all five years of age, who met eligibility for ART interruption with close monitoring were presented at CROI. Of the six, four experienced HIV remission for at least 48 weeks off ART. One of them experienced remission for 80 weeks, but had their HIV rebound to detectable levels. Three others have been in and remained in remission for 48, 52, and 64 weeks, respectively. Two children did not experience remission. The three children with viral rebound resumed suppression withing six, eight, and 20 weeks of restarting ART.

The study findings showed very early ART initiating has varying but favorable outcomes. Study authors caution close monitoring of ARS is needed in future HIV remission research involving ART interruption. Additional research is planned or underway to understand how study observations of standard therapy could differ in children receiving newer generations of antiretroviral drugs and identify biomarkers of the likelihood of HIV remission or rebound following ART interruption.

PIDS member and lead study virologist, Deborah Persaud, is quoted in the story. “This is the first study to rigorously replicate and expand upon the outcomes observed in the Mississippi case report. These results are groundbreaking for HIV remission and cure research, and they also point to the necessity of immediate neonatal testing and treatment initiation in health care settings for all infants potentially exposed to HIV in utero.”

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