South African child holds HIV at bay without drugs

The big HIV cure story from the IAS2017 conference in Paris is the case of HIV remission in a South African child. The child was diagnosed with HIV a month after birth and enrolled in a clinical trial studying early treatment. On the trial, the child took standard antiretroviral treatment for 40 weeks. Investigators then stopped treatment, and monitored the child for detectable virus and CD4 loss. It is now nearly 9 years since treatment was stopped. The child’s viral load has never rebounded to detectable levels.

Copyright: Marcus Rose/IAS
Photo shows: Avy Violari, University of the Witwatersrand, South Africa presenting the case.

Why is this case remarkable?

This case is one of only three extended cases of HIV remission in the world, and the first in Africa. Cases such as this have huge potential to reveal how HIV can be controlled without treatment. This feat is impressive, but it is not clear why this child controlled HIV when none of the other children on the trial did.

“We can’t tell if the immune system would have controlled the virus on its own or if the treatment made a difference,” Sharon Lewin, Director of The Peter Doherty Institute for Infection and Immunity.

What did the researchers find?

Since stopping treatment, no HIV has been found in the child’s plasma. A small amount of HIV DNA continues to be found in blood cells, but this virus does not seem able to replicate. The researchers established that the child is not an elite controller. This means they do not have a genotype that is protective from HIV disease. The researchers have looked at other features of the child’s immune response. So far, they have not definitively found anything that explains remission. The child has some features common to elite controllers. These include low levels of immune activation and low levels of the HIV co-receptor CCR5. On the other hand, the researchers could only find weak HIV-specific T cells, and the child has some genes that are sometimes linked to poor outcomes in HIV infection.

An excellent detailed and critical summary of the case written by Richard Jefferys can be found here. Jefferys includes an analysis of the media coverage, noting that most coverage has been accurate aside from the misreporting of the child’s gender, which was deliberately not disclosed.

It will be fascinating to follow this case, and to see what further investigations reveal.