A case study presented at the 8th IAS Conference on HIV Pathogenesis, Treatment & Prevention suggests that long-term HIV remission after early treatment could be possible in children infected via mother-to-child transmission, as a woman who was HIV-infected at birth is in viral remission despite not having taken any antiretroviral therapy (ART) for the last 12 years.

The woman was born in 1996 and infected at the end of pregnancy or at childbirth when her mother had an uncontrolled viral load. Even with zidovudine prophylaxis for six weeks, the child was HIV-positive one month after birth. Following discontinuation of the prophylactic treatment, two months later she had a very high viral load and treatment with four antiretroviral drugs was initiated. The ART was continued until the patient was nearly six years old, when she was lost to follow-up and her family opted to stop ART. She had an undetectable viral load on examination one year later and treatment was not resumed; today, she has a viral load that is still undetectable.

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Dr. Asier Sáez-Cirión, of the Institut Pasteur in Paris and one of the case study authors, adds that the patient has none of the genetic factors known to be associated with natural control of infection. It is believed that she has been in virological remission for so long due to receiving ART quickly after infection. Similarly, after a median of three years on ART, adult patients in the ANRS VISCONTI study also showed virological and immunological control of their infection for a median of 10 years. When ART is initiated very early, antiretrovirals may limit the constitution of reservoirs of HIV and preserve the body’s immune defenses. However, treatment discontinuation is not recommended in adults or children outside of clinical trials.

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