HIV in Remission for over 11 Years
A French teenager’s HIV infection is still in remission more than 11 years after her medications were discontinued, the longest hiatus on record for a young person and the best indication yet that long-term interruption of the infection is possible in children, a researcher revealed Monday.
The virus has been undetectable in the teenager’s blood since she was 21 months old, according to the information presented Monday at the 2015 International AIDS Society conference in Vancouver. She is now more than 18 years old and has not received anti-HIV medication since she was almost 6 years old. A blood test shortly before her seventh birthday showed no presence of the virus.
Asier Saez-Cirion, an assistant professor at the Pasteur Institute in Paris who conducted the research, was quick to note that the unidentified teen is not cured of HIV infection and that experts are not sure what caused her lengthy remission. With sophisticated tests, they can detect biological evidence of the virus in her blood, though not the virus itself.
“This girl is in remission,” Saez-Cirion said in an interview. “She’s not cured.”
Nevertheless, the case presents a number of possibilities for researchers seeking further progress against HIV, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
“There’s no measurable immunological reason why the [teen] is controlling” the virus, Fauci said. “But the [teen] is obviously controlling it.”
In 2013, doctors reported that they had achieved a “functional cure” for the HIV infection in a Mississippi girl who was put on anti-retroviral therapy within hours of her birth. But in July 2014 — 27 months after her aggressive treatment ended — her doctors announced that she had tested positive for HIV, a setback for researchers seeking to cure a disease that affects 35 million people around the world.
Another child in Italy who was thought to have been cured in 2014 relapsed after two weeks off the medication. A very small number of adults infected with HIV have been known to live many years without detectable levels of the virus in their blood despite ceasing treatment. Known as “elite controllers,” they have been studied in an effort to determine how they naturally keep their viral loads in check. In children, such a response is even more rare than among adults.
Steven Deeks, a professor of medicine at the University of California, San Francisco, said further research must confirm that the remission is real, rule out the possibility that the teen is an elite controller, determine the mechanism of control and try to predict who might benefit from the same approach.
“The real question here in the teenager is whether this is truly novel or whether this teenager would have controlled her virus anyway, the way others have in the past,” Deeks said.
Like the Mississippi child, the French teen was treated aggressively with anti-retroviral medication shortly after she was born to an HIV-infected mother whose illness was not controlled. It is uncommon to start drug therapy in a newborn before the virus is detected, but cases like these two may change that approach, Saez-Cirion said.
In this case, the girl was given the drug zidovudine as a preventive measure for six weeks after birth, when treatment was suspended. The virus was first detected in her blood at the age of four weeks, and her viral load peaked at three months, when she began receiving a regimen of four drugs.
A month later, the virus was undetectable and remained that way except for two occasions, when she was tested at 15 months and 21 months of age. Shortly before she turned 6, her family discontinued the combination therapy. A year later, she was tested again, and no virus was detected in her blood. A decision was made not to resume the medication.
As yet, there are only theories about the lengthy remission. Saez-Cirion noted the interruption in the girl’s treatment between six weeks and three months of age. Perhaps that allowed her to develop some kind of immunity, Saez-Cirion said.
“It means that for a few weeks, this girl was in contact with the virus, which may have been helping the immune system to combat the virus,” he said.
But if that’s true, Fauci noted, evidence of an immune response is not showing up in her blood tests. “That’s possible,” he said, “but they can’t measure it.”
Fauci pointed out that the child’s combination treatment began at three months “during what would be the functional equivalent of an acute infection,” when her viral load was very high. He wondered whether that timing helped her develop protection from the virus.
Saez-Cirion said he learned of the teen’s case after following the announcement of the Mississippi child’s remission. In recent months, his researchers have been running tests on the young woman to learn what they could about the teen’s condition before making news of her case public.
There is no way to predict the length of the teen’s remission, Saez-Cirion said. She very well may live a normal life span, he said, but as she ages, her immune system is likely to weaken, as most people’s do.
“We are not sure how long this may last,” he said. “Once people have been in remission for a couple of years, chances...are going to be higher.”
Lenny Bernstein Lenny Bernstein writes the To Your Health blog. He started as an editor on the Post’s National Desk in 2000 and has worked in Metro and Sports.
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