In what has been a remarkable step forward in the treatment of HIV, doctors have found that multiple children living with HIV who were being treated under an anti-retroviral medication protocol were able to achieve official remission status during a pause in their treatment.
Data presented at the 2024 Conference on Retroviruses and Opportunistic Infections in Denver, Colorado showed that 4 of 6 children were shown to have an absence of replication of the virus in their bodies for at least 48 weeks once they went off anti-retroviral treatment (ART). One of those children experienced remission for 80 weeks, the study found. That child's HIV viral load was then found to have rebounded to a detectable level. Three other children remained in remission for 48, 52 and 64 weeks, respectively, data showed.
ART medications have the goal of lowering a patient's viral load to a level that is not detectable, and therefore not transmissible.
Two children analyzed in the study did not experience remission, and their viral load became detectable within three to eight weeks after they were taken off their ART protocol.
Two children who saw their HIV return between 8 and 80 weeks later had mild acute retroviral syndrome, experiencing symptoms that included headache, fever, rash, swollen lymph nodes, tonsillitis, diarrhea, nausea and vomiting.
Dr. Deborah Persaud, a study author and professor of pediatrics at the Johns Hopkins University School of Medicine, said, "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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The study authors hope that the data will lead to better understanding of how early anti-retroviral treatment works, with results so far showing "varying but favorable outcomes on control of HIV," NIH wrote in a report out this week.
Adeodata Kekitiinwa, an emeritus clinical associate professor in the Department of Pediatrics at Baylor College of Medicine who worked on the study, said, "ART shifted the HIV care paradigm, but treatment is a long road, especially for children as lifetime HIV survivors."
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Leading the research were experts across the U.S. and in Zimbabwe and Tanzania who focus on global communities, including in Latin American countries such as Brazil.
Dr. Persaud called this the first study to "rigorously replicate and expand upon the outcomes" that were observed in the Mississippi case report. In that 2013 report, an infant born with HIV in Mississippi initiated treatment 30 hours after birth and was taken off of the anti-retroviral medication protocol at 18 months, and was observed to remain in remission with what doctors said was no evidence of a detectable viral load for HIV for 27 months.
Dr. Jeanne Marrazzo, a director at NIAID, said, "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."
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