Editors' ChoiceHIV/AIDS

A Chance of a Cure for HIV

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Science Translational Medicine  06 Nov 2013:
Vol. 5, Issue 210, pp. 210ec184
DOI: 10.1126/scitranslmed.3007933

Antiretroviral therapy suppresses HIV replication and is associated with remarkable improvements in morbidity and mortality. However, even with therapy HIV persists in reservoirs by integrating into the DNA of immune cells in infected persons, requiring lifelong treatment to control the virus. One previously reported patient was able to discontinue antiretroviral therapy with long-term control of the virus. This person had been treated for leukemia with a stem cell transplant from a donor whose cells were naturally resistant to HIV. This case and other research have resulted in tremendous efforts toward the possibility of eradicating HIV.

Persaud and colleagues now report the case of a child who was born to an HIV-infected woman who had not received prenatal care and thus had not received antiretroviral medications at the time of delivery. At 30 hours of age, the infant was started on a three-drug regimen of antiretroviral medications. The HIV RNA levels in the infant’s blood plasma and the presence of HIV DNA in the infant’s immune cells suggested that the infant was HIV-infected, likely during gestation rather than delivery. With therapy, the infant’s HIV RNA levels declined as expected to undetectable levels by 29 days. However, between 18 and 23 months of age the child was lost to follow-up and did not receive therapy. Nonetheless, despite not receiving therapy the child has not had any detectable HIV RNA in the blood plasma for the 5 months since returning to clinic. Using tests to detect HIV viral reservoirs by measuring HIV DNA inside immune cells, the authors found small traces of HIV genetic material in the child’s cells, but no virus with the ability to replicate or infect other cells. The child tested negative for genetic and immune markers that could have helped control HIV infection and has since had normal growth and development.

This report of one case suggests that very early multidrug antiretroviral therapy may modify the establishment and persistence of HIV infection in immune cells of infants exposed to HIV. However, longer follow-up of this child and larger studies are needed to determine whether this strategy will work to prevent establishment of long-term infection and eliminate the need for lifelong therapy in other HIV-infected infants.

D. Persaud et al., Absence of detectable HIV-1 viremia after treatment cessation in an infant. N. Engl. J. Med., published online 23 October 2013 (10.1056/NEJMoa1302976). [Full Text]

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