An infant was born by spontaneous vaginal delivery at 35 weeks to a woman who had received no prenatal care. Rapid HIV-1 testing in the mother was positive during labor and delivery occurred before anti-retroviral prophylaxis -- preventive medical treatment started immediately after exposure to a pathogen -- was administered.
Maternal HIV-1 infection was confirmed.
A combination of anti-viral drugs initiated in the infant at 30 hours of age to minimize the likelihood of generating resistant viral variants in the event that the infant had been infected in utero with HIV.
The infant remained on anti-virals until 18 months of age, at which point the child was lost to follow-up for a while and, physicians said, stopped treatment. Upon return to care, about 10 months after treatment stopped, the child underwent repeated standard HIV tests, none of which detected virus in the blood.
Early findings of the case were presented in March during a scientific meeting in Atlanta.
However, the report published in the New England Journal of Medicine adds detail and confirms what researchers say is the first documented case of HIV remission in a child.
The child's experience provides compelling evidence that HIV-infected infants can achieve viral remission if anti-retroviral therapy begins within hours or days of infection, the child's doctors said.
"Our findings suggest that this child's remission is not a mere fluke but the likely result of aggressive and very early therapy that may have prevented the virus from taking a hold in the child's immune cells," said lead author Dr. Deborah Persaud, a virologist and pediatric HIV expert at the Johns Hopkins Children's Center.
Persaud teamed up with immunologist Dr. Katherine Luzuriaga of the University of Massachusetts Medical School and pediatrician Dr. Hannah Gay of the University of Mississippi Medical Center, who identified and treated the baby and continues to see the child.
"We're thrilled that the child remains off medication and has no detectable virus replicating," Gay said. "We've continued to follow the child, obviously, and she continues to do very well. There is no sign of the return of HIV, and we will continue to follow her for the long term."
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