Following the pausing of antiretroviral therapy (ART) for HIV treatment, 4 children have achieved over a year of HIV remission, according to data presented at the 2024 Conference on Retroviruses and Opportunistic Infections in Denver.
Takeaways
- Early initiation of antiretroviral therapy (ART) within 48 hours of birth has led to HIV remission in 4 children for over a year, as presented at the 2024 Conference on Retroviruses and Opportunistic Infections.
- The study focused on children infected with HIV before birth and monitored them closely for HIV viral suppression and drug safety, with ART interruptions performed based on predefined criteria.
- Perinatal HIV transmission, occurring during pregnancy, birth, or through breastfeeding, remains a significant concern, but advancements in ART have decreased transmission rates. Lifelong ART is typically required for children who acquire HIV through perinatal transmission.
- A previous case report from 2013 showed no detectable HIV for 27 months in an infant who received ART early in life. The recent study built upon this data, evaluating the effects of very early ART initiation and ART interruptions.
- Out of 6 children aged 5 years in the study, 4 achieved HIV remission, defined as the absence of replicated HIV for at least 48 weeks after ART interruption. The study indicates promising outcomes for managing HIV in children and highlights the need for further research using updated antiretroviral drugs.
The study, funded by the National Institutes of Health, employed an ART regimen within 48 hours of birth. Participants included children infected with HIV prior to birth who were closely monitored for HIV viral suppression and drug safety. ART interruptions were performed once predefined virological and immunological criteria were met.
Perinatal HIV transmission defines when a child becomes infected with HIV in utero, during birth, or through milk consumption of a lactating individual. ART advancements have significant decreased perinatal HIV transmission rates, but lifelong ART is necessary in children who experience transmission.
Continuous treatment is normally required to prevent HIV resumption and protect patients from life-threatening conditions. However, a 2013 case report found no detectable HIV for 27 months in an infant born with HIV who received ART at 30 hours of life until they were aged 18 months. The recent study built on this data to evaluate very early ART initiation.
Eligibility criteria for ART interruption included durable absence of HIV replication from 48 weeks of ART initiation onward, no detectable antibodies near the time of ART interruption, and a CD4+ T-cell count similar to children with HIV. ART interruption was performed in children who met these criteria, were aged over 2 years, and no longer consumed breast milk.
Data from 6 children aged 5 years was presented, 4 of whom achieved HIV remission, defined as a lack of replicated HIV for at least 48 weeks after ART interruption. Of the children with HIV remission, 3 have remained in remission for 48, 52, and 64 weeks, respectively. One experienced a rebound of HIV levels after 80 weeks of remission.
For the children who failed to achieve HIV remission, HIV became detectable at 3 and 8 weeks following ART interruption, respectively. Mild acute retroviral syndrome (ARS) was reported in children with HIV detected at 8 and 80 weeks. Symptoms included rash, fever, headache, tonsillitis, swollen lymph nodes, diarrhea, nausea, and vomiting.
A case of low white blood cells was also reported. However, the issues of ARS or low white blood cells were resolved soon after resuming ART. HIV suppression in children with viral rebound was reported at 6, 8, and 20 weeks after resuming ART.
These results indicated favorable outcomes of very ART initiation for managing HIV. Further research is planned to examine outcomes in children receiving updated and more potent antiretroviral drugs.
“These findings are clear evidence that very early treatment enables unique features of the neonatal immune system to limit HIV reservoir development, which increases the prospect of HIV remission,” said Jeanne Marrazzo, MD, MPH, director of NIAID.
“The promising signals from this study are a beacon for future HIV remission science and underscore the indispensable roles of the global network of clinicians and study staff who implement pediatric HIV research with the utmost care,” Marrazzo added.
Reference
Children surpass a year of HIV remission after treatment pause. National Institutes of Health. March 6, 2024. Accessed March 7, 2024. https://www.nih.gov/news-events/news-releases/children-surpass-year-hiv-remission-after-treatment-pause
