Four HIV-positive babies achieved remission for more than a year after doctors treated them with aggressive medications, giving hope to research into treatments and cures.
From 2015 to 2017, scientists funded by the National Institutes of Health had treated dozens of HIV-positive infants with one of two different treatment regimens since birth. About five years later, they chose six children to stop the medication to test how long the remission would last.
In four of those six children, blood levels of HIV were completely undetectable for 12 to 18 months before reaching levels that were again detectable.
HIV can remain in the body, but at such low levels that the virus cannot be detected by blood tests, which also means that it cannot be transmitted to other people.
While the virus eventually returned in one of the young children, the sustained remission offered a glimmer of hope that scientists might soon discover a way for children born with the potentially deadly autoimmune virus to live normal, healthy lives.
The news comes just days after a 68-year-old California man with HIV and cancer was cured of both diseases after doctors essentially replaced his immune system with that of another person who had a genetic mutation that made him immune to HIV. .
Four children who acquired HIV in utero remain free of detectable HIV for more than a year (File photo)
The four children who went into remission were not named and their countries of birth were not specified, although the authors said most of the babies included were from sub-Saharan Africa, where HIV rates are highest.
The doctors who conducted the study, presented in a denver virology conferenceHe started with 440 babies and separated them into two groups or cohorts.
The first cohort consisted of babies born to HIV-positive mothers who were not receiving treatment for the disease. The second cohort included children born to HIV-positive mothers who were receiving antiviral treatment.
All babies began a preventive HIV treatment regimen known as antiretroviral therapy (ART) within 48 hours of their birth, even before their HIV status was confirmed.
ART is a treatment that prevents HIV from replicating in the body. It can also be taken by HIV-positive mothers to prevent transmission of the virus to their baby during pregnancy, childbirth or breastfeeding.
If a mother with HIV takes the medication throughout her pregnancy and the birth of her baby to have a suppressed amount of the virus in her blood, and her newborn receives ART within a few hours after birth, the chances of transmitting HIV to the baby They are less than one percent.
Of the babies in the study, 54 babies (34 in the first group and 20 in the second group) had confirmed HIV when they were born. Thirty-three of them were women.
Six children were considered eligible to stop taking their antiretroviral therapy regimen around age five as part of the study, based on certain criteria indicating that their HIV levels were under control and that their immune systems were strong enough to to endure a medication break.
In four of those children, HIV remained at undetectable levels for 48 weeks, 52 weeks, 64 weeks, and 80 weeks.
The first three children are still in remission and are being monitored for the study, while the fourth child’s HIV recovered after 80 weeks.
Dr. Ellen Chadwick, lead researcher behind the study, saying: ‘This remission was much longer than we had anticipated.
“We are not surprised or discouraged if they rebound because that is what usually happens when treatment is stopped.” If we can get the virus to such low levels that we can use some newer, more innovative treatments to prevent them from needing medication every day, then we will be setting them up for success with long-term virological control.’
The latest study follows a 2013 case report known as the ‘Mississippi baby,’ which described a girl born in Mississippi in 2010 to a mother with HIV and who herself had HIV. Doctors started treatment within 30 hours of her birth with a powerful combination of antiretroviral therapies.
When she was 18 months old, the family stopped antiretroviral treatment and she remained medication-free for the next 27 months with undetectable levels of HIV in her blood.
It was encouraging for scientists, who have been working for decades on a way to save children from a lifetime of taking this drug. But the baby’s HIV spiked when she was about to turn four.
Dr Deborah Persaud, who reported on the Mississippi case and co-led the latest study, said: “This is the first study to rigorously replicate and extend the results seen in the Mississippi case report.
“These results are groundbreaking for HIV remission and cure research, and also point to the need for immediate neonatal testing and initiation of treatment in healthcare settings for all infants potentially exposed to HIV in utero.”
HIV (human immunodeficiency virus) attacks the body’s own immune system, leaving it unable to fight infections and diseases such as blood cancer.
Once a person has it, it stays in the body for life, although levels of the virus in the blood can get so low that tests don’t detect it, which is the goal when receiving treatment.
HIV is not equivalent to AIDS, which occurs when HIV is not treated. Not all people with HIV will develop full-blown disease thanks to advances in prophylactic medications over the past three decades.
The resulting remissions among those children do not amount to a cure, but they indicate that the drug is effectively suppressing the replication of the virus, which in turn means that a person is less likely to transmit it to their sexual partners.
HIV is primarily transmitted through sex and sharing needles, but it can also be passed from mother to child.
Dr Chadwick said: “We don’t know exactly why they did so well, but we think it’s because we reduced the reservoir to such a low level that the virus didn’t re-emerge in the same way it would in someone with a larger reservoir. and more established”, that is, points on the body where the virus hides.
Reducing the reservoir – or limiting the number of “hiding places” available for the virus in the body – meant that it was harder for HIV to re-emerge and cause new infections or symptoms.
About 1.2 million Americans and about 39 million people worldwide have HIV, and there is currently no cure, although scientists are focusing on the power of stem cells, which have the ability to become myriad different types of cells in the body, including immune cells overcome by HIV.
Paul Edmonds, a 68-year-old California man who was cured of HIV and a type of blood cancer, was treated for cancer with stem cell therapy.
It involves replacing stem cells damaged by chemotherapy with healthy cells from a donor, when doctors saw a unique opportunity: finding a donor with a genetic mutation resistant to HIV.
They found one and transplanted stem cells that had two copies of a rare genetic mutation called CCR5 delta-3, which makes people resistant to HIV. Only one or two percent of the population has this mutation.
HIV uses the CCR5 receptor to attack the immune system, but the CCR5 delta-3 mutation prevents the virus from infecting the receptor.
The transplant completely replaced Mr. Edmond’s bone marrow and blood stem cells with those of the donor.
Since the 2019 transplant, he has shown no signs of cancer or HIV.
Three other people have been in sustained HIV remission in Berlin, London and, most recently, Dusseldorf. That patient underwent a transplant very similar to Mr. Edmond’s.
‘Berlin patient’ Timothy Ray Brown was successfully cured of the HIV virus 16 years ago
Adán Castillejo, 40, was the second person in the world to be cured of HIV. Earlier this year he revealed that he was the ‘London patient’.
The Dusseldorf patient underwent allogeneic hematopoietic stem cell transplantation (HSCT) in February 2013 after chemotherapy for his leukemia, supervised by an international research team, led by doctors from the University Hospital Dusseldorf.
It involved destroying the patient’s diseased blood cells and replacing them with those from a donor, who had the CCR5 mutation in his genes.
The patient continued taking antiretroviral therapy after the transplant to prevent HIV from replicating in the body.
The virus became undetectable in his blood, so he stopped taking daily medications in November 2018, six years after the stem cell transplant.
The team of doctors ruled that the Dusseldorf patient was in remission from HIV, adding that his case provided “strong evidence” that the transplant cured him of the virus.