Born with HIV, living free of infection

By Sola Ogundipe

A 9-year-old South African child that was born with HIV is now free of infection.  The unnamed child was treated briefly with antiretroviral therapy (ART) as a baby, and has successfully suppressed the virus for more than eight years after stopping the medication.

The announcement, made at the opening of the International AIDS Society (IAS) Conference on HIV Science, in Paris Monday this week, noted that  the child shows no signs of infection and is now virtually “cured.”

The child in question was one of 377 HIV-infected children that participated in a research trial that investigated the possibility of treating children with ART and then stopping the treatments for extended periods.

As a 32-day old infant diagnosed with HIV, the child received antiretroviral drugs (medication that stops the virus from replicating).  By 40 weeks, the immune system was in good shape with no symptoms of infection. Scientists are still trying to figure out what makes the child’s immune system so special.

Researchers do not fully understand why the child is doing so well, but say it could be as a result of the antiretroviral therapy in addition to factors that are genetic or immune system-related.

The child’s case is further proof that early treatment in infants, children and adults could cause a long remission to prevent the need for life-long therapy and probably act as a form of cure.

Early HIV therapy reduces the damage to the immune system that HIV causes in the first few weeks and months of infection.

Most patients need drugs daily to prevent HIV attacking the immune system and causing AIDS, but now remaining HIV free for so long without a rebound gives hope of the possibility of a permanent cure.

This would not be the first case of long-term HIV remission in a child after early HIV treatment was halted. In 2013, a team of researchers from Johns Hopkins Children’s Centre,  University of Mississippi Medical Centre and the University of Massachusetts Medical School described the first case of elimination of HIV infection in children.

A baby girl (famously called Mississippi baby) who received ART just 30 hours after birth until she was 18 months old sustained remission for 27 months, until 2015 when the virus was rediscovered in her blood.

It was later established that prompt administration of antiviral treatment likely halted the formation of hard-to-treat viral reservoirs—dormant cells responsible for reigniting the infection in most HIV patients within weeks of stopping therapy.

The infant was deemed “functionally cured” a condition that occurs when a patient achieves and maintains long-term viral remission without lifelong treatment and standard clinical tests are unable to detect HIV replication in the blood.

Also, a French child started anti-HIV therapy at three months and stopped treatment sometime between ages 5.5 years and 7.0 years. The child continues to be healthy more than a decade and a half later.

At least a dozen adults also have had remissions lasting for years after stopping HIV medicines.

Currently, high-risk newborns—those born to mothers with poorly controlled infections or whose mothers’ HIV status is discovered around the time of delivery—receive a combination of antivirals at prophylactic doses to prevent infection for six weeks and start therapeutic doses if and once infection is diagnosed. But this particular case, the investigators say, may change the current practice because it highlights the curative potential of very early ART.

Specialists say a short course of HIV drugs given early enough in infancy may prevent life-long therapy and help close the doors permanently against new HIV infections.

Nigeria has the largest paediatric HIV infection in the world. A report by the National AIDS and STIs Control Programme, NASCP, shows that Nigeria currently ranks the 2nd largest HIV epidemic in the world (3.4 million). There are 1.7 million HIV positive women and 380,000 children under15 years in the country.

Participants at a recent meeting in Calabar, Cross Rivers State, called for enhanced access to PMTCT services and increased number of pregnant women living with HIV to be initiated on lifelong antiretroviral medicines.

The meeting, organised by UNICEF for the Journalists Alliance for PMTCT in Nigeria, JAPIN, agreed that acceleration of treatment for all pregnant and breastfeeding women living with HIV is still

needed to achieve elimination of new infections among children and halving HIV related deaths among pregnant women and new mothers.

UNICEF HIV/AIDS Specialist, Dr. Abiola Davies, noted that HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth and breastfeeding.“Mother-to-child transmission, also known as vertical transmission accounts for the vast majority of new infections in children.

Without treatment, the likelihood of HIV passing from mother-to-child is 15-45 per cent, but ART and other effective interventions reduce the risk to below five per cent. Davies noted that even though PMTCT is not 100 per cent effective, elimination of HIV is desirable as a reduction of transmission to low levels (below five  per cent) that it no longer constitutes a public health problem.

Mother-to-child HIV transmission accounts for over 90 per cent of new HIV infections among children. HIV transmission rates without intervention rate between 15 and 45 per cent but this rate can be reduced to less than five per cent with effective interventions in the periods of pregnancy, labour, delivery and breastfeeding. Primarily, the interventions include ARV treatment for the mother and a short course of ARVs for the baby.

From findings, many more HIV positive pregnant women need to be   accessing PMTCT services during antenatal care. Key PMTCT indicators from the 2015 Annual report on HIV/AIDS Health Sector response in Nigeria, show that 53,677 (30.16 per cent) of the HIV-infected pregnant women received antiretroviral drugs to reduce risk of mother-to-child transmission (MTCT), while 27,486 (15.44 per cent) of HIV exposed infants received ARV prophylaxis for the PMTCT within the first six weeks of birth.

From the NASCP report, 51.2 per cent of the babies born to HIV positive pregnant women that had PMTCT interventions received the first dose of Nevirapine and 29.6 per cent had DNA PCR done within two months of birth.

To eliminate MTCT appreciably, at least 20 per cent of all HIV positive women must have access to reliable HIV prevention interventions such as contraceptives; 70 per cent of all pregnant women and breastfeeding mothers should receive quality HIV testing, counselling and ARVs, while 55 per cent of all HIV-exposed infants are expected to be receiving ARV prophylaxis and 45 per cent all HIV-exposed infants receiving early infant diagnosis services by the end of 2016.

According to the NASCP, it is expedient to ensure that the prevalence of HIV among children is reduced in line with global trends. Emphasis should be on guidelines towards the global targets relating to PMTCT in reducing the number of new HIV infections among children to fewer than 40,000 by 2018 and fewer than 20,000 by 2020.

Calls were also made for commitment to ensure that 95 per cent of pregnant women living with HIV receive lifelong HIV treatment by 2018, while support for pregnant and breastfeeding women should be sustained.

JAPIN pointed out that the current standard of care is to start HIV-infected babies on antiretroviral drugs as early as their diagnosis and treat them for the rest of their lives.

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