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South African boy, believed to have been infected
with HIV around the time of his birth, has remained
free of the virus for 8½ years after early treatment —
renewing hope among scientists that such outliers
may hold clues to help end the decades-old
epidemic.
The case study, described by researchers before a
presentation Monday at an international AIDS
conference in Paris, suggests a paradigm shift in the
treatment of those infected. It establishes that HIV
may be controllable in some way other than a daily
and lifelong regimen of antiretroviral drugs.
“This is really the first step toward HIV remission and
a cure,” said Deborah Persaud, a virologist at Johns
Hopkins Children’s Center in Baltimore.
“Understanding the factors that came into play to
lead to this outcome is really going to inform
science.”
Out of the millions of children worldwide who are
HIV-positive, the boy, now 9, is one of only three who
have been identified by scientists as having the ability
to stop the virus from resurging for an extended
period of time.
Anthony Fauci, head of the National Institute of
Allergy and Infectious Diseases, struck notes of both
optimism and caution when speaking about him.
Fauci described the child as being in “remission”
rather than being cured. And while hoping the boy
would never have an active infection in his lifetime,
Fauci noted that HIV tends to hide in “funny places”
and that it is “not entirely inconceivable” a small
amount of the virus may remain in his body and start
replicating again.
It is exciting to see this. It is encouraging to see a
child going for such a long period of time without
rebounding,” Fauci said. “But we don’t have the full
answers to what this means yet.”
The first case of extended remission in a child was
announced to great excitement in 2013. Startled
researchers reported that a girl — who came to be
known as the Mississippi baby — appeared to be
“functionally cured” 23 months after stopping
treatment. The celebration was premature, however:
The virus returned shortly after that announcement,
and the young girl had to be put back on
medications. But her case brought to light the
possibility of viral suppression in children and led to
the funding of other research into the phenomenon.
The second case, reported in 2015, involved a French
teen who underwent treatment from soon after birth to
age 6 and whose blood continued to have
undetectable levels of the virus for 12 years after
stopping the drugs.
The South African boy came to the attention of
researchers in 2008 through a larger study funded by
the National Institutes of Health. It took place from
2005 to 2011 at hospitals near Johannesburg and
Cape Town and involved nearly 400 HIV-positive
babies.
Mark Cotton, a pediatric AIDS expert and one of the
lead authors of the paper being presented Monday in
Paris, explained that children were randomly put in
one of three groups. One received the standard of
care at the time, which was to start therapy only
when the individual showed signs of becoming sick or
evidence of a weakened immune system. The other
two groups started treatment immediately after their
HIV-positive status was confirmed, and stopped after
40 weeks or 96 weeks, respectively. The goal was to
figure out whether early treatment was better than
deferred treatment.
Cotton said the data appeared to show that children
who had the virus rebound earlier had to go back on
medication after a couple of weeks. But there was a
huge surprise for subjects whose remission lasted
longer, he said, with several children not needing to
return for two or more years after 96 weeks of
treatment.
For the 40-week treatment group, the average
remission period was about 30 weeks; for the 96-
week treatment group, it was about 70 weeks —
although researchers caution that the results are still
being analyzed and should be taken as very
preliminary.
Yet the one boy is already considered a distinct
outlier. Born to an HIV-positive mother, he was taken
to one of the clinics in the study when he was about
8 weeks old. He began therapy when he had a
relatively low viral load, and he took liquid
antiretrovirals twice a day until he was about 48
weeks of age. By the time he was done treatment just
before his first birthday, the viral load was
undetectable, and year after year during follow-up
visits, he continued to show no signs of an actively
replicating virus.
One of the leading theories about how children in the
study who had the longest remission might be
different has to do with how their immune systems
give them the power to suppress any rebound.
Another factor may be that their very early treatment
did not give the virus a chance to fully establish
itself.


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