Children Achieve Year-Long HIV Remission After Treatment Pause

Newly released findings from the IMPAACT P1115 study have unveiled a significant milestone in pediatric HIV treatment. Researchers at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI), presented results that four children with HIV surpassed a year of remission after pausing their antiretroviral therapy (ART).

HIV, which is a virus that weakens the immune system, has long posed a significant health challenge worldwide, particularly affecting children born with the virus. While ART has dramatically improved life expectancy and quality of life for those living with HIV, achieving sustained remission without continuous treatment has remained an elusive goal.

The IMPAACT P1115 study is a Phase I/II, multi-center, proof-of-concept study that is exploring the effects of early ART regimens on achieving HIV remission in infants. It’s being conducted by the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network, which is funded by the National Institutes of Health. The study enrolled children who acquired HIV before birth and were started on an ART regimen 48 hours after birth. They were closely monitored for drug safety and viral suppression, and interruptions were made to treatment once the children met predetermined virological and immunological criteria. Key findings from the study include:

• Six children at the age of five were deemed eligible to have their ART paused and undergo a closely monitored treatment interruption.
• Out of those six children, four remained free of detectable HIV for more than one year after stopping ART.
• One child experienced remission for 80 weeks before their HIV presented to detectable levels.
• Two children did not achieve remission, and their HIV presented again within three to eight weeks of ART interruption. They experienced mild acute retroviral syndrome, which was resolved after restarting ART.

These findings build on the case of the "Mississippi baby", which was the first reported instance of a child achieving long-term HIV remission after early treatment in 2013. The IMPAACT P1115 study is the first to replicate and expand upon those outcomes. Researchers emphasized that these results are groundbreaking for HIV remission and cure research and highlighted the importance of immediate neonatal testing and treatment initiation for all infants exposed to HIV. While this is a positive step forward, further research is planned for the observation of newer generation of ART drugs and identifying biomarkers to predict HIV remission and rebound.

References

Children surpass a year of HIV remission after treatment pause. National Institutes of Health. March 2024. https://www.nih.gov/news-events/news-releases/children-surpass-year-hiv-remission-after-treatment-pause

Highleyman L. Some children who start antiretrovirals very early may control HIV after stopping treatment. aidsmap.com. March 2024. https://www.aidsmap.com/news/mar-2024/some-children-who-start-antiretrovirals-very-early-may-control-hiv-after-stopping

Samuelson K. Children born with HIV surpass a year of remission after pausing treatment. Northwestern Now. March 2024. https://news.northwestern.edu/stories/2024/03/children-born-with-hiv-surpass-a-year-of-remission-after-pausing-treatment/

Lurie Children’s Hospital of Chicago | Pediatric Medicine. March 2024. https://www.luriechildrens.org/en/news-stories/children-born-with-hiv-surpass-a-year-of-remission-after-pausing-treatment/

Art-free HIV-1 remission in very early treated children: Results from IMPAACT P1115 - Croi Conference. CROI Conference -. March 2024. https://www.croiconference.org/abstract/art-free-hiv-1-remission-in-very-early-treated-children-results-from-impaact-p1115/