Virus World

A recent NIH-funded study shows potential for long-term HIV remission in children without medication, marking a significant advance in treatment. Announced at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Colorado, a groundbreaking study funded by the National Institutes of Health has unveiled that four children born with HIV were able to live for more than a year without detectable levels of the virus after their HIV medication was paused. This finding from the P1115 study hints at the potential for achieving long-term remission in children born with HIV, a significant stride in the ongoing battle against the virus.

Early Intervention: A Ray of Hope

The P1115 study focused on the impact of early intensive antiretroviral therapy (ART) in infants infected with HIV before birth. HIV, a virus that attacks the immune system, can hide within the body, making it challenging to eradicate. However, these children's ability to live more than a year without medication and with no detectable virus brings new optimism to scientists and medical professionals. It suggests that early, aggressive treatment may limit HIV reservoirs, potentially enabling periods of remission in pediatric patients.

The Mississippi Baby: Pioneering Early Treatment

Inspired by the case of the "Mississippi Baby," who was born with HIV and received intensive ART hours after birth and was seemingly cured for a few years, researchers have been motivated to explore the possibility of long-term remission in children. Although the "Mississippi Baby" eventually tested positive for HIV again at age 4, the case provided invaluable insights into the potential benefits of early and aggressive treatment. The NIH has since invested in global research studies, like P1115, to further investigate these possibilities.

Implications for Future Treatment

While all children in the P1115 study eventually saw their HIV return, the period during which some of them had no detectable HIV without taking medication marks a significant discovery. According to Adeodata Kekitiinwa, MBChB, MMed, the study's investigator of record, this trial moves us closer to a paradigm shift in HIV treatment. It raises the possibility that antiretroviral therapy could be used effectively for a "season of life," rather than being a lifelong necessity. This potential shift could dramatically change the approach to treating children born with HIV, offering them a chance at a healthier life without the constant burden of medication. The study's findings not only fuel hope for achieving long-term remission among children born with HIV but also underscore the importance of continuous research and innovation in the field. As scientists work towards unlocking the secrets of HIV remission, these children's stories stand as beacons of possibility, pointing towards a future where HIV can be managed more effectively, and perhaps, eventually overcome.

HIVACAT T-cell immunogen (HTI) is a novel human immunodeficiency virus (HIV) vaccine immunogen designed to elicit cellular immune responses to HIV targets associated with viral control in humans. The AELIX-002 trial was a randomized, placebo-controlled trial to evaluate as a primary objective the safety of a combination of DNA.HTI (D), MVA.HTI (M) and ChAdOx1.HTI (C) vaccines in 45 early-antiretroviral (ART)-treated individuals (44 men, 1 woman; NCT03204617). Secondary objectives included T-cell immunogenicity, the effect on viral rebound and the safety of an antiretroviral treatment interruption (ATI). Adverse events were mostly mild and transient. No related serious adverse events were observed. We show here that HTI vaccines were able to induce strong, polyfunctional and broad CD4 and CD8 T-cell responses.

All participants experienced detectable viral rebound during ATI, and resumed ART when plasma HIV-1 viral load reached either >100,000 copies ml−1, >10,000 copies ml−1 for eight consecutive weeks, or after 24 weeks of ATI. In post-hoc analyses, HTI vaccines were associated with a prolonged time off ART in vaccinees without beneficial HLA (human leukocyte antigen) class I alleles. Plasma viral load at the end of ATI and time off ART positively correlated with vaccine-induced HTI-specific T-cell responses at ART cessation. Despite limited efficacy of the vaccines in preventing viral rebound, their ability to elicit robust T-cell responses towards HTI may be beneficial in combination cure strategies, which are currently being tested in clinical trials. Vaccines that elicit HIV-specific T-cell responses did not prevent viral rebound in people living with HIV upon antiretroviral treatment (ART) interruption, but associated with longer time off ART in some trial participants, suggesting their immunogenicity may benefit future cure approaches.

Published In Nature Medicine (Oct. 27, 2022):

https://doi.org/10.1038/s41591-022-02060-2