First case of prolonged remission (12 years) in an HIV

Paris, 20 July 2015
Press release
First case of prolonged remission (12 years) in an HIVinfected child
A young woman now aged 18 and a half, who at birth was HIV-infected via mother-to-child
transmission (during pregnancy or at delivery), is in virological remission, despite not
having taken any antiretroviral therapy for the last 12 years. Monitored in the French ANRS
pediatric cohort, this young woman seems to have benefited from the treatment that was
initiated shortly after her birth and stopped approximately six years later. Her case suggests
that long-term remission after early treatment is possible in children infected by HIV since
birth, as demonstrated in adults in the ANRS VISCONTI study.
This first case in the world of long-term remission in a child will be presented as an oral
communication by Dr Asier Sáez-Cirión (HIV, Inflammation and Persistence Unit, Institut
Pasteur, Paris) at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis,
Treatment and Prevention to be held from 19 to 22 July in Vancouver, Canada. This work,
supported by the ANRS, was conducted by research teams at the Institut Pasteur, Inserm
and Paris university hospitals.
A French study has shown, for the first time, that long-term remission from HIV infection can be
achieved in a child infected during the perinatal period, after discontinuation of antiretroviral therapy
begun during the first months of life. This observation concerns a girl born in 1996 and monitored in the
French ANRS pediatric cohort. She was infected at the end of pregnancy or at childbirth when her
mother had an uncontrolled viral load (quantity of virus in the blood). Despite zidovudine prophylaxis for
six weeks, the child was nonetheless HIV-positive one month after birth. Two months later, following
discontinuation of the prophylactic treatment, she had a very high viral load, which prompted initiation of
treatment with four antiretroviral drugs.
This treatment was continued until the child was almost six years old. She was then lost to follow-up
and her family decided to stop the antiretroviral therapy. On examination one year later by her medical
team, she was found to have an undetectable viral load (<50 copies of HIV RNA per mL of blood). Her
doctors then decided not to resume treatment.
Twelve years later, now aged 18 and a half, she has a viral load that is still undetectable, as measured
with a particularly low detection threshold (<4 copies of HIV RNA per mL of blood), despite never
having resumed antiretroviral treatment. Her CD4 cell count has remained stable throughout this period.
Dr Asier Sáez-Cirión, of the HIV, Inflammation and Persistence Unit at the Institut Pasteur in Paris,
notes that “This girl has none of the genetic factors known to be associated with natural control of
infection. Most likely she has been in virological remission for so long because she received a
combination of antiretrovirals very soon after infection.”
This case is clinically, immunologically and virologically similar to that of the adult patients of the study
ANRS VISCONTI who, after a median of three years on antiretroviral therapy, initiated at primary
infection (ie, during the first few months after infection), showed virological and immunological control of
their infection for a median of 10 years, without having resumed antiretrovirals 1. Started very early,
antiretrovirals may limit the constitution of reservoirs of HIV and preserve the body’s immune defenses.
Dr Sáez-Cirión explains that “With this first, highly documented case of this young woman, we provide
the proof of concept that long-term remission is possible in children, as in adults. However, these cases
are still very rare. A similar case of an HIV-infected infant treated early was described in the United
States (the so-called ‘Mississippi baby’), but remission lasted just 27 months after antiretroviral therapy
was stopped. Treatment discontinuation is therefore not recommended in adults or children outside
clinical trials.”
ANRS Director Professor Jean-François Delfraissy points out that “This prolonged remission in a child
born seropositive is a major clinical observation that opens up new research perspectives. This
remission, however, should not be equated with a cure. This young woman is still infected by HIV and it
is impossible to predict how her state of health will change over time. Her case though constitutes a
strong additional argument in favor of initiation of antiretroviral therapy as soon as possible after birth in
all children born to seropositive mothers.”
The Research Agency ANRS (France REcherche Nord&sud Sida-hiv Hépatites) was set up in 1988. It brings
together researchers from different fields and institutions in the developed world and resource-limited countries
to study scientific questions on HIV/AIDS and viral hepatitis. The ANRS funds research projects approved by
international expert committees. It supports projects from conception to completion and actively participates in
communicating the results to ensure that they are used for the benefit of the populations concerned. Its annual
budget of approximately 45 million euros is provided by the ministries of research and health. In 2012, the
ANRS became an autonomous agency of Inserm (French National Institute of Health and Medical Research).
Abstract
HIV-1 virological remission for more than 11 years after interruption of early initiated antiretroviral therapy in a perinatally-infected child.
Pierre Frange1,2,3, Albert Faye4,5, Véronique Avettand-Fenoël1,2, Erianna Bellaton6, Diane Descamps7,8, Mathieu Angin9, Sophie Caillat-Zucman10,11,
Gilles Peytavin12,13, Le Chenadec J14,15, Josiane Warszawski14,15, Christine Rouzioux1,2 and Asier Saez-Cirion9, on behalf of the French ANRS EPFth
CO10 Pediatric Cohort. . 8 IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 19-22, Vancouver (Canada),
th
abstract n°MOAA0105LB, oral communication, July 20 , 2015.
1
Laboratoire de Microbiologie clinique, Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Necker – Enfants malades, Paris, France;
EA7327, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; 3Unité d’Immunologie, Hématologie et Rhumatologie pédiatriques, AP-HP,
Hôpital Necker – Enfants malades, Paris, France; 4Service de Pédiatrie générale, AP-HP, Hôpital Robert Debré, Paris, France; 5Université Paris 7
Denis Diderot, Paris Sorbonne Cité, Paris, France; 6Service d’Hématologie pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France; 7Laboratoire de
Virologie, AP-HP, Hôpital Bichat – Claude Bernard, F-75018, Paris, France; 8INSERM UMR1137 IAME, Université Paris Diderot, F-75018, Paris,
France; 9 Institut Pasteur, Unité HIV inflammation et persistance, Paris, France; 10Laboratoire d'Immunologie, AP-HP, Hôpital Robert Debré, Paris,
France; 11INSERM UMR1149, Université Paris Diderot, Paris, France; 12Laboratoire de Pharma-Toxicologie, AP-HP, Hôpital Bichat, F-75018, Paris,
France; 13IAME, INSERM UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; 14Service d’Epidémiologie et de Santé publique,
AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, France; 15INSERM U1018, Université Paris Sud, Le Kremlin Bicêtre, France
2
Scientific contact
Vancouver : Dr Asier Sáez-Cirión
Email : [email protected]
ANRS contact
[email protected]
1
Sáez-Cirión A, Bacchus C, Hocqueloux L Avettand-Fenoel V, Girault I, Lecuroux C, Potard V, Versmisse P, Melard A, Prazuck T,
Descours B, Guergnon J, Viard JP, Boufassa F, Lambotte O, Goujard C, Meyer L, Costagliola D, Venet A, Pancino G, Autran B,
Rouzioux C; ANRS VISCONTI Study Group. Post-Treatment HIV-1 Controllers with a Long-Term Virological Remission after the
Interruption of Early Initiated Antiretroviral Therapy, PLoSPathog. 2013 Mar;9(3):e1003211doi: 10.1371/journal.ppat.1003211.
PLoSPathog. 2013;9(3):e100321