Ever since one child, dubbed the ‘Mississippi baby,’ went into drug-free remission of HIV in 2013, experts have wondered if giving treatment within hours of birth might do the same for others.

The results of a new trial conducted in Africa suggest it can: Four out of six newborns infected at birth with HIV went into long-term remission after prompt treatment with antiviral drugs.

“This is the first study to rigorously replicate and expand upon the outcomes observed in the Mississippi case report,” noted lead study author Dr. Deborah Persaud, who also reported the Mississippi case.

“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,” Persaud, a professor of pediatrics at the Johns Hopkins University School of Medicine in Baltimore, said in a Hopkins news release.

According to Persaud, the new findings could change “the treatment paradigm for this infection that currently afflicts 1.7 million children around the world.”

Persaud and her colleagues presented the findings this week in Denver at the Conference on Retroviruses and Opportunistic Infections.

Traditionally, newborns infected with HIV via their mothers are started on antiretroviral therapy weeks after birth, the researchers noted.

The Mississippi baby’s experience was different: She received treatment just 30 hours after delivery and was taken off antiretroviral therapy (ART) at 18 months of age. She went on to be the first documented case of HIV remission in a child who was born with the virus.

The new trial sought to replicate that. It took place at 30 clinical research sites in 11 countries. In its latest phase, researchers tracked outcomes for six children born in sub-Saharan Africa who all tested positive for HIV at birth.

All began receiving ART within 48 hours of delivery, in an effort to drive HIV into remission. When they reached the age of 5, doctors interrupted each child’s ART to see if their remission held without medication. Researchers closely monitored the children for any health or safety issues.

Four of the six did achieve hoped-for remission from HIV, defined as undetectable HIV after 48 weeks without treatment.

Three of the children have remained in remission for 48, 52 and 64 weeks each, while a fourth did begin to show detectable signs of the virus again at about 80 weeks.

“This remission was much longer than we had anticipated,” noted study protocol chair Dr. Ellen Chadwick. “We’re not surprised or crestfallen if they rebound because that’s what usually happens when medications are stopped.”

However, “if we can get the virus to such low levels that we might be able to use some newer, innovative treatments to keep them from needing medication every day, then we’re setting them up for success with long-term virologic control,” she explained.

Two of the children whose HIV rebounded developed mild signs of HIV illness and were placed back on ART, after which their symptoms subsided and their HIV levels declined to undetectable levels.

The remaining two children enrolled in the trial failed to experience HIV remission despite early treatment. Their HIV levels became detectable between three to eight weeks after ART was interrupted.

For those children who do go into remission, “moving away from reliance on daily ART to control HIV would be a huge improvement to the quality of life,” said Chadwick, a professor of pediatric infectious diseases at Feinberg School of Medicine in Chicago and  former director of the section of pediatric, adolescent and maternal HIV infection at Lurie Children’s Hospital in Chicago.

Speaking in a hospital news release, Chadwick said it’s not clear how early treatment pushes HIV into remission in the very young but not older patients.

“We think it’s because we reduced the [HIV] reservoir to such a low level that the virus didn’t re-emerge in the same way it would in someone with a larger, more established reservoir,” she said.

Of course, this approach only works if babies are known to be HIV-positive soon after delivery.

It “relies on testing at birth, which is not universally done,” noted Dr. Jennifer Jao, protocol co-chair, a professor of pediatric infectious diseases at Feinberg and a Lurie Children’s researcher and physician.

“The idea that we’re doing this in neonates is very novel,” she said in the Lurie news release. “It’s taking this idea of getting ART into the babies so early that we can try to smack down the virus so it goes down to such low levels and achieve an almost-zero reservoir.”

The next phase of this research will involve interrupting ART at an even earlier age, such as when children reach the age of 2, the researchers said.

Because these findings were presented at a medical meeting they should be considered preliminary until published in a peer-reviewed journal.

More information

Find out more about HIV treatment at HIV.gov.

SOURCES: Johns Hopkins Medicine and Ann and Robert H. Lurie Children’s Hospital of Chicago, news releases, March 6, 2024

Source: HealthDay

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