A three-year-old US girl who was given emergency treatment within 30 hours of being born with AIDS remains free from the deadly virus even after 18 months - the first time HIV has been put into remission in a child.
The child from Mississippi was born to an HIV-infected mother and began combination anti-retroviral treatment 30 hours after birth, according to a new report.
A series of tests in the subsequent days and weeks showed progressively diminishing viral presence in the infant's blood, until it reached undetectable levels 29 days after birth.
The infant remained on antivirals until 18 months of age, at which point the child was lost to follow-up for a while and, physicians the 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, according to the report.
"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," said pediatrician Hannah Gay of the University of Mississippi Medical Center.
The report confirms what researchers claim 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, according to the report in the New England Journal of Medicine.
The investigators said the prompt administration of antiviral treatment likely led to the child's remission because it halted the formation of hard-to-treat viral reservoirs - dormant HIV hiding in immune cells that reignites the infection in most patients within mere weeks of stopping drug therapy.
Remission, defined in this case not only by absence of infection symptoms but also by lack of replicating virus, may be a stepping stone toward a sterilising HIV cure - complete and long-term eradication of all replicating virus from the body, the report said.
"Prompt antiviral therapy in newborns that begins within hours or days of exposure may help infants clear the virus and achieve long-term remission without the need for lifelong treatment," Deborah Persaud, lead author of the report said.
Ultra-sensitive tests designed to sniff out trace amounts of virus intermittently detected viral footprints in the child, Persaud said.
However, this "leftover" HIV appears incapable of forming new virus and reigniting infection.
Importantly, the child exhibits none of the immune characteristics seen in the so-called "elite controllers," a tiny percentage of HIV infected people whose immune systems allow them to naturally keep the virus in check without treatment.