A child with perinatal HIV infection and long-term sustained virological control following antiretroviral treatment cessation

Avy Violari,James Mcintyre,Afaaf Liberty,Diana Gibb,Caroline T Tiemessen,Maria Paximadis,Shayne Loubser,Kennedy Otwombe,Diana B Schramm,Sharon Shalekoff,Abdel Babiker,Louise Kuhn,Bianca Da Costa Dias,Mark F Cotton

doi:10.1038/s41467-019-08311-0

Abstract

Understanding HIV remission in rare individuals who initiated antiretroviral therapy (ART) soon after infection and then discontinued, may inform HIV cure interventions. Here we describe features of virus and host of a perinatally HIV-1 infected child with long-term sustained virological control. The child received early limited ART in the Children with HIV Early antiRetroviral therapy (CHER) trial. At age 9.5 years, diagnostic tests for HIV are negative and the child has characteristics similar to uninfected children that include a high CD4:CD8 ratio, low T cell activation and low CCR5 expression. Virus persistence (HIV-1 DNA and plasma RNA) is confirmed with sensitive methods, but replication-competent virus is not detected. The child has weak HIV-specific antibody and T cell responses. Furthermore, we determine his HLA and KIR genotypes. This case aids in understanding post-treatment control and may help design of future intervention strategies.

Highlights

Soon after infection and discontinued, may inform HIV cure interventions
Cell count and per cent at 61 days, prior to antiretroviral therapy (ART) start, were 2249 cells per μL and 41.6%. These values fell within the respective baseline interquartile ranges (IQRs) for all early treated children who stopped ART in the Children with HIV Early antiRetroviral therapy (CHER) trial (Supplementary Table 2)—
We report virological and immunological characteristics in a

Summary

Introduction

Soon after infection and discontinued, may inform HIV cure interventions. We describe features of virus and host of a perinatally HIV-1 infected child with long-term sustained virological control. The child received early limited ART in the Children with HIV. The child has weak HIV-specific antibody and T cell responses. We determine his HLA and KIR genotypes. This case aids in understanding post-treatment control and may help design of future intervention strategies. Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, PO Box 114, Diepkloof, Soweto 1864, South Africa. Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa.

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