You are here
SUSTAINED REMISSION IN A 4-YEAR-OLD HIV-INFECTED CHILD TREATED IN FIRST YEAR OF LIFE
Gloria P. Heresi1, Douglas D. Richman2, Roukaya Al Hammoud1, Gilhen Rodriguez1, Norma Perez1, James R. Murphy1
1University of Texas at Houston, Houston, TX, USA,2University of California San Diego, La Jolla, CA, USA
Very rarely children with vertically acquired HIV and given antiretroviral therapy (ART) soon after birth, then stop ART, have extended periods without detectable HIV in peripheral blood by routine testing. We report a child with intrauterine-acquired HIV, who started on combined antiretroviral therapy at 33 hours of life and remains undetectable over 3 years after discontinuing ART.
In addition to routine clinical assays, HIV DNA was assayed using droplet digital PCR (ddPCR) for gag and pol using DNA extracted from available CD4 lymphocytes purified by negative selection.
A healthy newborn was born to a mother with no prenatal care and a 6-year history of diagnosed, but untreated HIV infection, with 14,400 HIV RNA copies/ml and 27% CD4 at delivery. The child was started on ART at 33 hours of life. A blood sample submitted for HIV DNA on day of life (DOL) 1 and another for HIV RNA on DOL 2 failed due to technical issues. A DOL 14 sample tested positive for HIV DNA. Because of this finding dried blood spots from DOL 1 from routine newborn screening were tested for HIV DNA with a positive result (CDC). The mother discontinued the childs ART after 1 year. From birth through 4 years old the child remained clinically well with undetectable HIV RNA (<20) by routine laboratory testing, and HIV specific antibodies becoming and remaining negative from 15 months. Testing by HIV ddPCR-DNA was performed at intervals beginning at DOL 114 and were intermittently detected with the most recent one showing <1 copy of gag and pol DNA/ million CD4 cells.
We present a child with intrauterine- acquired HIV infection, initiation of ART at 33 hour of life who was maintained on ART for 1 year and has remained clinically well through 4 years of age including 3 years without ART. Whether viral control was affected by ART, characteristics of the child or virus are being investigated.