Four babies with HIV enter remission after receiving experimental drug regimen in NIH-funded study — a potential breakthrough for hundreds of children born to infected mothers each year

Four HIV-positive babies were able to achieve remission for more than a year after doctors treated them with aggressive drugs, giving hope for research into treatment and a cure.

From 2015 to 2017, scientists funded by the National Institutes of Health had treated dozens of HIV-positive babies since birth with one of two different treatment regimens. About five years later, they chose six children to interrupt the medication to test how long remission would last.

In four of these six children, HIV levels in their blood were completely undetectable for twelve to eighteen months before reaching levels that became detectable again.

HIV can remain in the body, but at such low levels the virus cannot be detected by blood tests, which also means it cannot be spread to others.

While the virus eventually returned in one of the toddlers, the continued remission offered a glimmer of hope that scientists could soon discover a way for children born with the potentially fatal autoimmune virus to live normal, healthy lives.

The news comes just days after a 68-year-old California man with both HIV and cancer was cured of both diseases after doctors essentially replaced his immune system with that of another person who had a genetic mutation that made him immune to HIV.

The four children who went into remission were not named and their countries of birth were not specified, although the authors said most of the babies came from sub-Saharan Africa, where HIV rates are the highest.

Doctors conducting the study, presented at a Virology conference in Denverstarted with 440 babies and divided them into two groups, or cohorts.

Cohort one consisted of babies born to HIV-positive mothers who were not receiving treatment for the disease. The second cohort included children born to HIV-positive mothers who received antiviral treatment.

All babies started a preventive HIV treatment program known as antiretroviral therapy (ART) within 48 hours of birth, even before their HIV status was confirmed.

ART is a treatment that prevents the replication of HIV in the body. It can also be taken by HIV-positive mothers to prevent transmission of the virus to their babies during pregnancy, childbirth or breastfeeding.

If a mother with HIV takes the drug during her pregnancy and the birth of her baby so that the amount of virus in her blood is suppressed, and her newborn is given ART within hours of birth, the risk of transmitting HIV to the baby is taller. are less than one percent.

Of the babies in the study, 54 babies (34 from the first group and 20 from the second group) had confirmed HIV at birth. Thirty-three of them were women.

As part of the study, six children were eligible to stop taking their antiretroviral therapy at around five years old, based on certain criteria indicating that their HIV levels were under control and that their immune systems were strong enough was to endure a drug break.

In four of these children, HIV levels remained at undetectable levels for 48 weeks, 52 weeks, 64 weeks and 80 weeks.

The first three children are still in remission and are being monitored for the study, while the fourth child’s HIV status recovered after 80 weeks.

Dr. Ellen Chadwick, the lead researcher behind the study, said: ‘This remission took much longer than we expected.

“We are not surprised or dejected when they recover because that is what usually happens when the medications are stopped.” “If we can get the virus down enough that we can maybe use newer, innovative treatments to keep them from needing medications every day, then we’re setting them up for success with long-term virological control.”

The latest study stems from a 2013 case report known as the “Mississippi baby,” which described a girl born in Mississippi in 2010 to a mother with HIV who also had HIV herself. Doctors began treatment with a powerful combination of antiretroviral therapies within 30 hours of her birth.

When she was 18 months old, the family stopped taking ART and she remained off the drugs for the next 27 months, with undetectable levels of HIV in her blood.

It was encouraging for scientists, who have been working for decades to find a way to save children from a lifetime of drug use. But the baby’s HIV virus recovered when she was about to turn four.

Dr. Deborah Persaud, who reported the Mississippi case and co-led the latest study, said, “This is the first study to rigorously replicate and extend the results from the Mississippi case report.

‘These results are groundbreaking for HIV remission and cure research, and also highlight the need for immediate neonatal testing and initiation of healthcare treatment for all infants who may have been exposed to HIV in utero.’

HIV – the human immunodeficiency virus – attacks the body’s own immune system, rendering it unable to fight infections and diseases such as blood cancer.

Once someone has it, it stays in the body for life, although the level of the virus in the blood can become so low that tests cannot detect it, which is the goal of treatment.

HIV is not the same as AIDS, which results from leaving HIV untreated. Not everyone with HIV will develop full-blown disease thanks to advances in prophylactic drugs over the past thirty years.

The resulting remissions among these children do not equate to a cure, but they indicate that the medication effectively suppresses the virus’s replication, which in turn means a person is less likely to pass it on to sexual partners.

HIV is mainly transmitted through sex and sharing needles, but can also be transmitted from mother to child.

Dr. Chadwick said: ‘We don’t know exactly why they did so well, but we think it’s because we got the reservoir down to such a low level that the virus didn’t reemerge in the same way it would in someone with an illness . larger, more established reservoir, i.e. places in the body where the virus can hide.

Reducing the reservoir – or limiting the number of available ‘hiding places’ for the virus in the body – made it harder for HIV to reemerge and cause new infections or symptoms.

About 1.2 million Americans and about 39 million people worldwide have HIV, and there is currently no cure, although scientists are focusing on the power of stem cells, which have the ability to develop into many different cell types in the body. including immune cells that are overtaken by HIV.

Paul Edmonds, the 68-year-old California man who was cured of HIV and a form of blood cancer, was treated for the cancer with stem cell therapy.

This involves replacing stem cells damaged by chemotherapy with healthy cells from a donor – when doctors saw a unique opportunity: finding a donor with an HIV-resistant genetic mutation.

They found one and transplanted stem cells that had two copies of a rare genetic mutation called CCR5 delta-3, which makes people resistant to HIV. Only one to two percent of the population has this mutation.

HIV uses the receptor CCR5 to attack the immune system, but the CCR5 delta-3 mutation blocks the virus from infecting the receptor.

The transplant completely replaced Mr. Edmond’s bone marrow and blood stem cells with those of the donor.

Since the transplant in 2019, he has shown no signs of cancer or HIV.

Three other people from Berlin, London and most recently Düsseldorf are in lasting remission from HIV. That patient underwent a transplant very similar to Mr. Edmond’s.

The patient from Düsseldorf underwent an allogeneic hematopoietic stem cell transplant (HSCT) in February 2013 after chemotherapy for his leukemia, under the supervision of an international research team, led by doctors from the University Hospital of Düsseldorf.

It involved destroying the patient’s unhealthy blood cells and replenishing them with those from a donor, who had the CCR5 mutation in his genes.

The patient continued to take antiretroviral therapy after the transplant to prevent HIV from replicating in the body.

The virus became undetectable in his blood, so he stopped taking daily medications in November 2018 – six years after the stem cell transplant.

The team of doctors ruled that the Dusseldorf patient was in remission from HIV, adding that his case provided “strong evidence” that the transplant cured him of the virus.