A new study offers cautious optimism in the ongoing effort too eradicate pediatric HIV, demonstrating that long-term remission is absolutely possible in a small number of infants who began antiretroviral therapy immediately after birth. The IMPAACT P1115 study,involving researchers across 11 countries,investigated whether very early treatment could allow newborns infected in utero to maintain viral control even after stopping medication. While remissions remain rare-observed in just a fraction of the 52 infants enrolled-the findings build upon previous cases,including that of the “Mississippi baby” in 2013,and may refine strategies for achieving a functional cure for children living with HIV.
A study examining early infant HIV treatment in resource-limited countries has shown that a small number of newborns achieved long-term remission after stopping antiretroviral therapy, offering a glimmer of hope in the fight against pediatric HIV. The research, known as IMPAACT P1115, explored the feasibility of newborn screening and very early initiation of antiretroviral treatment to achieve remission without ongoing medication.
The IMPAACT P1115 study was launched shortly after the case of the “Mississippi baby,” the first reported pediatric case of virological remission following very early antiretroviral treatment in a child infected through vertical transmission. However, that initial remission proved to be temporary. (More information about the “Mississippi baby” case is available here, and additional research from Deborah Persaud can be found here.)
Since then, other pediatric cases of remission have been reported, including one in France, though these instances appear to be less common than remissions observed in adults who began treatment during acute infection and then discontinued it years later. This period of initial infection, known as primo-infection The first contact of an infectious agent with a living organism. This is a key moment for diagnosis and prevention due to extremely high viral loads. Individuals are highly contagious during this period., is characterized by very high viral loads and is a period of significant contagiousness.
The study included newborns living with HIV Human Immunodeficiency Virus. Isolated in 1983 at the Pasteur Institute in Paris; its discovery was recently (2008) awarded the Nobel Prize in Medicine to Luc Montagnier and Françoise Barré-Sinoussi. who were infected in utero. Participants either began antiretroviral therapy immediately after birth (Cohort 1) or within 48 hours of birth (Cohort 2). Children over 2 years of age who had been weaned from breastfeeding for more than 6 weeks and met specific immunological and virological criteria were offered a planned interruption of treatment. These criteria included undetectable plasma HIV RNA levels, at least two negative HIV antibody tests, and at least two undetectable HIV DNA measurements spaced at least 8 weeks apart, along with normal CD4 counts for their age.
Of the 52 children enrolled, six met the criteria for treatment interruption at a median age of 5.5 years. Two of these six experienced early viral rebound (at 3.4 and 9.4 weeks after stopping treatment), while the remaining four maintained virological remission for at least 48 weeks. One child eventually experienced viral rebound at 79.3 weeks off treatment, while the other three remained in remission at 49.6, 51.9, and 64 weeks without treatment.
Overall, the study confirms that, similar to adults treated during acute infection, some infants infected in utero who initiate treatment within 48 hours of birth and achieve viral suppression may experience remission after stopping treatment several years later. The findings suggest that early intervention can have a lasting impact on viral control in some infants. However, the underlying mechanisms behind these remissions remain unclear, and further research is needed to determine if they are the same mechanisms observed in adults who achieve post-treatment control.
The study also highlights that these situations appear to be rare in pediatrics. Researchers had to collaborate with 30 sites across 11 countries to enroll 52 infants infected in utero and treated very early, and only six ultimately met the strict criteria for planned treatment interruption.
