SA child’s HIV ‘mir­a­cle’

A child’s mirac­u­lous HIV re­mis­sion in SA has sparked spec­u­la­tion that a cure for the deadly disease is not far off

YOU (South Africa) - - CONTENTS - BY KHATIJA NXEDLANA SOURCES: WITS UNIVER­SITY, BUSI­NESS LIVE

THE dis­cov­ery was de­scribed as one of the most ex­cit­ing devel­op­ments in the war against a ram­pant virus once re­garded as a death sen­tence. A South African child who was di­ag­nosed with HIV 32 days af­ter birth had beaten the virus into long-term re­mis­sion – al­most nine years af­ter re­ceiv­ing a drug cock­tail as part of a clin­i­cal trial as a baby.

This child is the third one with HIV to go into re­mis­sion and has given sci­en­tists re­newed hope of find­ing a cure for a virus that af­fects 36,7 mil­lion peo­ple – seven mil­lion of them in South Africa.

The child is re­garded as “func­tion­ally cured”, mean­ing there are still traces of the virus in their sys­tem but it’s so weak it can’t repli­cate or spread to oth­ers.

Here’s a look at the re­mark­able case and what it could mean for those liv­ing with HIV.

NEW HOPE The break­through was on ev­ery­one’s lips at the re­cent In­ter­na­tional Aids So­ci­ety (IAS) Con­fer­ence on HIV Sci­ence in Paris, France. At the age of one month the child, whose iden­tity is pro­tected, was en­rolled in a Chil­dren with HIV Early An­tiretro­vi­ral Ther­apy (CHER) trial led by Dr Avy Vi­o­lari and Dr Mark Cot­ton.

When the child was nine weeks old the treat­ment sup­pressed the virus to un­de­tectable lev­els and med­i­ca­tion was stopped as part of the trial process.

Doc­tors have main­tained a close watch on the child’s im­mune sys­tem and the pres­ence of the virus.

“This is the first re­ported case of sus­tained con­trol of HIV in a child en­rolled in a ran­domised trial fol­low­ing treat­ment early in in­fancy,” Vi­o­lari says.

PROMIS­ING POS­SI­BIL­I­TIES The key lab in­ves­ti­ga­tions were led by Pro­fes­sor Caro­line Tiemessen of the Na­tional In­sti­tute for Com­mu­ni­ca­ble Dis­eases, who’s a vi­rol­ogy re­searcher at the school of pathol­ogy at Wits Univer­sity in Johannesburg.

“We be­lieve there may have been other fac­tors in ad­di­tion to early an­tiretro­vi­ral ther­apy (ART) that con­trib­uted to HIV re­mis­sion in this child,” she says. “By study­ing the child, we could ex­pand our un­der­stand­ing of how the im­mune sys­tem con­trols repli­ca­tion of HIV-1 [the strain of the virus the child was born with].”

But just be­cause this child showed a pos­i­tive re­sponse to treat­ment doesn’t mean all kids will re­act in the same way.

“We think the ge­net­ics of the child and the child’s im­mune re­sponse are com­po­nents that aided this out­come.”

OTHER “MIR­A­CLES” The case of the SA child is the third re­ported in­stance of sus­tained HIV-1 re­mis­sion in a child af­ter early lim­ited ART treat­ment. The first case, a baby in Mis­sis­sippi in the USA born with HIV-1 in 2010, re­ceived ART 30 hours af­ter birth, stopped treat­ment at 18 months and con­trolled the virus with­out drugs for 27 months be­fore it reap­peared in her blood.

The sec­ond case, re­ported in 2015, was a French child born with HIV-1 in 1996 who started ART three months af­ter birth, stopped treat­ment some­time be­tween five-and-a-half and seven years, and con­tin­ues to con­trol the virus.

THIS ISN’T A GEN­ERAL CURE Pro­fes­sor Deenan Pil­lay, vi­rol­ogy pro­fes­sor at the Univer­sity of KwaZulu-Na­tal, says it’s im­por­tant not to cre­ate the im­pres­sion that chil­dren can stop tak­ing the med­i­ca­tion in light of what hap­pened with the nine-year-old SA child.

“We have to re­mem­ber that HIV in­fects a huge num­ber of chil­dren and adults and this is just one case that’s come up,” he warns.

“The most in­ter­est­ing thing is what we can learn about this par­tic­u­lar child – the child’s im­mune sys­tem and ge­net­ics and whether there’s any­thing that can teach us why the child may have been able to con­trol the virus. It’s th­ese lessons that can in­form how we de­velop vac­cines that will be ef­fec­tive for ev­ery­one.” S

Dr Avy Vi­o­lari Pro­fes­sor Caro­line Tiemessen

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