CityPress - - News - ZINHLE MAPUMULO zinhle.mapumulo@city­

Could a lit­tle South African girl be the an­swer to an Aids-free gen­er­a­tion? Al­though it’s too early to tell, sci­en­tists believe she has brought them closer to find­ing a cure to a dis­ease that killed at least

1 mil­lion peo­ple world­wide just last year.

The nine-year-old, whose iden­tity has been with­held to pro­tect her and her fam­ily, made his­tory re­cently when she proved to be the first child par­tic­i­pat­ing in an early an­tiretro­vi­ral (ARV) ther­apy trial to con­trol HIV af­ter stop­ping treat­ment.

The news of her abil­ity to achieve re­mis­sion af­ter be­ing in­fected with the virus at birth sur­faced on Mon­day at the ninth In­ter­na­tional Aids So­ci­ety Con­fer­ence on HIV Science in Paris.

Avy Vi­o­lari, head of pae­di­atric re­search at the Peri­na­tal HIV Re­search Unit in the Fac­ulty of

Health Sciences, Univer­sity of the Wit­wa­ter­srand, re­ported the case at the con­fer­ence.

Vi­o­lari co-led the Chil­dren with HIV Early An­tiretro­vi­ral Ther­apy tri­als in which the sym­bolic case emerged, with Mark Cot­ton, head of the Divi­sion of Pae­di­atric In­fec­tious Dis­eases and di­rec­tor of the Fam­ily In­fec­tious Dis­eases Clin­i­cal Re­search Unit at Stel­len­bosch Univer­sity.

Vi­o­lari said that, as far as the team knew, “this is the first re­ported case of sus­tained con­trol of HIV in a child en­rolled in a ran­domised trial of ARV treat­ment in­ter­rup­tion fol­low­ing treat­ment early in in­fancy”. The lit­tle girl was in­fected with HIV at birth. She was di­ag­nosed as HIV-pos­i­tive in 2007, when she was a month old, and was then en­rolled on the Chil­dren with HIV Early An­tiretro­vi­ral Ther­apy clin­i­cal trial, funded by the Na­tional In­sti­tute of Al­lergy and In­fec­tious Dis­eases, where she started re­ceiv­ing HIV treat­ment.

Be­fore start­ing the treat­ment, the child had a high vi­ral load, but, at about nine weeks old, the ARVs had sup­pressed the virus to un­de­tectable lev­els. Ten months af­ter start­ing treat­ment, the treat­ment was stopped and her im­mu­nity was closely mon­i­tored. Caro­line Tiemessen, the se­nior au­thor of this case and re­search pro­fes­sor in vi­rol­ogy in the School of Pathol­ogy at Wits, who led the key lab­o­ra­tory in­ves­ti­ga­tions, said the child had re­mained in good health dur­ing years of fol­low-up ex­am­i­na­tions. “We believe there may have been other fac­tors in ad­di­tion to early ARV treat­ment that con­trib­uted to HIV re­mis­sion in this child. By fur­ther study­ing the child, we may ex­pand our un­der­stand­ing of how the im­mune sys­tem con­trols HIV-1 repli­ca­tion,” said Tiemessen, who is also the Na­tional Re­search Foun­da­tion de­part­ment of science and tech­nol­ogy re­search chair in HIV vac­cine trans­la­tional re­search, and head of cell bi­ol­ogy at the Cen­tre for HIV and STIs of the Na­tional In­sti­tute of Com­mu­ni­ca­ble Dis­eases in Johannesburg.

How­ever, this was not the first time that an HIVin­fected child who was treated early on achieved re­mis­sion. In 2010, a baby in Mis­sis­sippi re­ceived ARVs 30 hours af­ter birth and stopped ther­apy at around 18 months of age. While the child man­aged to con­trol the virus with­out drugs for 27 months, it then reap­peared in her blood. In 2015, re­searchers re­ported that another child – born with HIV in 1996 – who started anti-HIV ther­apy at the age of three months and stopped treat­ment some­time be­tween the ages of five and seven, had con­tin­ued to con­trol the virus with­out drugs more than 11 years later.

Anthony Fauci, the di­rec­tor of the Na­tional In­sti­tute of Al­lergy and In­fec­tious Dis­eases, said: “All three cases strengthen our hope that, by treating chil­dren in­fected with HIV for a brief pe­riod be­gin­ning in in­fancy, we may be able to spare them the bur­den of life­long ther­apy and the health con­se­quences of long-term im­mune ac­ti­va­tion typ­i­cally as­so­ci­ated with HIV-1.”

How­ever, he said that “fur­ther study is needed to learn how to in­duce long-term HIV re­mis­sion in in­fected ba­bies”.


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