A 9 ½ -year old girl under clinical guidance stopped her HIV therapy 8 ½ years ago and is doing just fine: Are we onto something or is this just a one-off?




Very few people can control HIV for more than a few weeks without antiretroviral (ARV) drugs. But a 9 ½ -year-old girl in South Africa has been doing it for over 8 ½ years now, according to a case presentation this week at the International AIDS Society Conference in Paris, as reported in the journal Science.

The girl (her name is being withheld) was born to an HIV-infected mother and was given ARVs starting at 8 weeks old. The treatment was stopped at 40 weeks as part of a clinical trial and today, remarkably, she’s doing just fine. Although there is a caveat – the virus remains in her system but the level is so low it’s invisible with standard tests, detectable only by an ultrasensitive DNA sequencing method.

Researchers believe the key to the girl’s sustained remission was starting her ARV treatment shortly after she become infected – 8 weeks later. The trick, they say, is to strike the right balance between using drugs early to keep the HIV load small, yet large enough for the immune system to see enough HIV to develop a robust memory response for when the virus comes back.

More good news: This same approach has been successful – so far – in an ongoing study at the Pasteur Institute in Paris. They’re following 23 patients who started ARV treatment shortly after becoming infected. The average treatment length was 3 years. And 7 years post-treatment (on average because people entered the study at different times) the virus remains undetected in all 23. One person in the group has gone without treatment for nearly 17 years.

But these are early days for this approach and as a recent Oxford University early-treatment study reminds us, getting it right isn’t easy: the virus remained undetectable in 14% of the people in one cohort (the longer treatment group), and just 4% in the other.

And as Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia, observes with respect to the girl in South Africa: “Single-case reports have limited value now. … We know it happens and we need to understand why.”

Nevertheless, Mark Cotton, PhD, one of the South African researchers says, “It’s exciting that we’ve identified the child, as it could provide answers for the future.” But he cautions, “There’s a long way to go.”





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