At the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, Dr Asier Saez-Cirion (HIV, Inflammation and Persistence Unit, Institut Pasteur) presented the world’s first case of prolonged remission, in a child being monitored in the French ANRS pediatric cohort.
Now a young woman of eighteen and a half, she was infected at birth by mother-to-child transmission and is now in virological remission, despite not having taken any antiretroviral therapy for the last twelve years. Monitored in the French ANRS pediatric cohort, this young woman seems to have benefited from the treatment that was initiated shortly after her birth and was continued for almost six years before being stopped. Her case suggests that long-term remission after early treatment may be achieved in children infected with HIV at birth, as demonstrated in 20 adults in the ANRS VISCONTI study.
As a result of your study, are you able to confirm the reasons why this young woman is in remission?
Dr Asier Saez-Cirion: Our work has demonstrated for the first time that long-term remission from HIV infection can be achieved in a child infected during the perinatal period, following discontinuation of effective antiretroviral therapy begun very early on, during the first few months of life.
We have proved that this child has none of the genetic factors known to be associated with natural infection control. Most likely she has been in virological remission so long because she received a combination of effective antiretrovirals very soon after infection.
If started very early, antiretrovirals may limit the constitution of viral reservoirs and preserve the body’s immune defenses. However, remission of infection is a rare phenomenon, and is without doubt due to a combination of several factors, possibly including factors that are specific to the host.
What is the difference between this young patient and the adult patients in the ANRS VISCONTI cohort?
Dr Asier Saez-Cirion: From a clinical, immunological and virological point of view, the case of this young woman is similar to that of adult patients in the ANRS EP47 VISCONTI study who, after a median of three years on antiretroviral therapy, initiated at primary infection (i.e. during the first few months after infection), showed virological and immunological control of their infection for a median of ten years, without having resumed antiretrovirals.
Prior to this study, the only known case of remission in children had been the Mississippi Baby, who subsequently lost control of the infection after 24 months. Given the immaturity of this child’s immune system, it was not then known whether prolonged remission was possible in children.
Did this young patient and the ANRS VISCONTI cohort receive a particular type of treatment?
Dr Asier Saez-Cirion: All these patients received standard treatment comprising different combinations of antiretroviral molecules, providing optimal infection control. These are treatments to which patients routinely have access in clinical settings. The common factor between the cases we are currently studying is that the treatment was started very soon after infection.
How will this discovery change the treatment provided for AIDS patients?
Dr Asier Saez-Cirion: This first, highly documented case should certainly encourage an overall strategy to administer antiretrovirals, within the weeks following birth, to all babies infected during pregnancy or delivery. However, we are as yet unable to predict who will benefit from a remission following discontinuation of treatment. It has been amply shown that uncontrolled infection following discontinuation of treatment has negative consequences for the patient. For this reason, discontinuation of antiretroviral treatment is not recommended, either in adults or in children, outside clinical trials.
In what respects is the IAS Conference an important event for scientists carrying out research into HIV?
Dr Asier Saez-Cirion: The IAS Conference is the largest international gathering of people involved in the fight against AIDS. This conference is unique in that it involves not only scientists, but also clinicians, community representatives, patients, etc., who meet to share the latest developments in fundamental and clinical research and the possible application of these results. In addition, since 2010 this conference has been preceded by the Towards an HIV Cure symposium, which has become a benchmark for specialists working on strategies for HIV remission and cure. This symposium was created on the initiative of Françoise Barré-Sinoussi, a scientist at the Institut Pasteur, who was awarded the Nobel Prize in Medicine in 2008 for her discovery of HIV.
This work was funded by the ANRS and conducted with the collaboration of teams from the Institut Pasteur, Inserm and the Paris University Hospitals.
Updated on 21/07/2015