Philip over the years Goulder is obsessed with a particularly fascinating idea: Can kids get answers in finding a cure for HIV?
Starting in the mid-2010s, pediatricians and immunologists at the University of Oxford began working with scientists in KwaZulu-Natal, South Africa, to track hundreds of children who get HIV from their mothers, whether during pregnancy, during childbirth or breastfeeding.
After putting children in their lifetime to control the virus early on taking antiretroviral drugs, Gould and his colleagues were eager to monitor their progress and adhere to standard antiretroviral treatments, thus preventing HIV replication. But over the next decade, something unusual happened. Five of the kids stopped going to the clinic to collect drugs, and when the team finally tracked them down months later, they seemed to be in good health.
“Instead of viral load passing through the roof is undetectable,” Gould said. “It is usually an HIV rebound in two or three weeks.”
In a study published last year, Gould described that despite not receiving antiretroviral drugs regularly for a period of time, all five people remained in remission, but for up to 17 months in one case. In search of a cure for HIV for decades, this provides an attractive insight: the first success in curing HIV may not be in adults, but in children.
At the recent International AIDS Society conference held in Kigali, Rwanda, in mid-July, Alfredo Tagarro, a pediatrician at the Infanta Sofia University Hospital in Madrid, presented a new study showing that around 5 percent of HIV-infected children who receive antiretrovirals within the first six months of life ultimately suppress the HIV viral reserve—the number of cells harboring the virus’s genetic material—to negligible level. “Children have special immunologic characteristics that make it more likely that we will develop HIV treatments for other populations before they can be developed,” Tagarro said.
His idea was responded by another doctor, Mark Cotton, who directed the clinical research department of childhood infectious diseases at the University of Stellenbosch in Cape Town.
“The child’s immune system is more dynamic,” said Cotton. “They don’t have any other problems, either, such as high blood pressure or kidney problems. It initially makes them a better target for cures.”
According to Tagarro, children with HIV have long been “forgotten” to find a treatment that can permanently relieve HIV-positive individuals. Since 2007, it is believed that 10 adults have undergone stem cell transplants to treat life-threatening blood cancer, and the surgery ultimately eliminates the virus. However, because such procedures are both complex and highly risky – other patients die in similar attempts – it is not a viable strategy specifically targeting HIV.
Instead, like Goulder, pediatricians are increasingly noting that after the onset of antiretroviral treatment in early life, a small subpopulation of children appears to be able to suppress HIV for months, years, and even use only their immune system to permanently suppress HIV. This awareness started with some isolated case study: “Mississippi babies,” who controlled the virus for more than two years without drugs, while South African children were believed to be able to cure the virus for more than a decade. Cotton said he suspected that 10 to 20% of all children infected with HIV were able to control the virus for a long period of time within a typical two to three weeks after stopping the antiretroviral.
