In 1996, a baby infected with HIV at birth was launched on AIDS drugs. But 6 years, against the advice of doctors, his family stopped treatment. Twelve years later, the young French woman is still healthy, with no detectable virus in the blood. His unusual case, announced today at an international AIDS conference in Vancouver, Canada, may hold clues that could help other people with HIV infections without control their antiretroviral (ARV) and offer overview vaccine developers against AIDS.
case adds a new wrinkle to earlier reports of people who can control their HIV infections on their own: the so-called elite controllers, who never received treatment still remove the virus at low levels, and post-treatment controllers as the "Mississippi baby," who stopped taking ARVs to 18 months of age and has remained virus free for over 2 years. in 2013, many researchers thought that the child could have been "cured", but HIV has come back strong after 27 months of stopping treatment
This time, it is clear that the French woman is no cure. investigators found strong signals of HIV DNA in his immune cells and can easily get them to produce a virus, said Asier Sáez-CIRION, a viral immunologist at the Pasteur Institute in Paris, who reported the case. But it is the first child infected with documented HIV treatment to go off and remain in remission during this period. "We do not know why this happened," said Sáez-CIRION.
Some clues may come from a group of people infected with HIV in adulthood, known as the Visconti cohort who went out ARVs and did not have the return of the virus for many years. As Sáez-CIRION and colleagues described in the March 2013 issue PLoS Pathogens , adults were diagnosed shortly after they have been infected, started ARVs immediately, and stayed on them for an average of 3 years. at the time of this publication, the average person had been out ARV for 7 years. Sáez-CIRION and colleagues added the new case to the Visconti group, which now has 20 members.
the people in the Visconti cohort look surprisingly different from elite controllers, the 1% of people infected with HIV who have high levels of virus, even in the first weeks of infection, despite never receiving treatment. Although no single factor explains the unusual ability of elite controllers to control HIV, many are genetically predisposed to have high levels of CD8 lymphocytes that identify and eliminate cells infected with HIV.
post-treatment controllers, like the people in Visconti, have high levels of virus soon after infection and their immune systems are deteriorating rapidly. Paradoxically, many have a genetic makeup that predisposes them to a low adaptive immune response to the virus.
Sáez-CIRION think they can get help instead of the more primitive system and less powerful "innate" immune serving as a first line of defense against invaders. Researchers suspect that the innate immune system may be strong enough to contain HIV if people have very little viral DNA tanks. The members of the Visconti cohort began treatment so quickly after infection these tanks have not had a chance to complete.
Another, somewhat against-intuitive, possibility is that the weak immune response in post-treatment controllers limits the size of the tank before the drugs are even started. HIV preferentially targets and infects CD4 white blood cells that help fight infections. A low CD4 response to the virus means fewer targets to infect
Sáez-CIRION also suggests a third possibility :. Some post-treatment controllers are being infected by a weaker form of the mutant virus resulting from the replication of HIV errors.
Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases of the United States, said he is intrigued by the new French case and place the child with Mississippi. "There's something about the immune system of a very young," says Fauci. "The child Mississippi was a tickler for us, and I would not throw the window of 27 months is a long time. Maybe, somehow, the way the child kept the virus under control is the same as the new case. I have a completely open mind. "
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