In the recent 12th International AIDS Society (IAS) HIV Science Conference (IAS 2023), a research study from South Africa found that, despite seldom adhering to antiretroviral therapy (ART), 5 male children who were born with HIV still maintained undetectable viral loads. Researchers believe that due to innate immunological gender differences, boys might have a better chance of achieving sustained virological remission than girls.
In early case reports of children initiating combination antiretroviral therapy (cART), it was hypothesized that some children treated at an extremely early age could achieve viral control without requiring further interventions. To verify this hypothesis and identify potential controlling mechanisms, researchers conducted a longitudinal study in the KwaZulu-Natal province of South Africa, monitoring 281 mother-child pairs with in utero HIV infections post-delivery.
All children in the study received cART at birth; 92% of the patients had already acquired cART through their mothers before birth (in utero). The study found that maintaining viral control highly depended on adherence to cART and was not related to the infant’s baseline plasma viral load. Over time, it was observed that 5 male patients (aged 3 to 19 months) still achieved sustained virological suppression even with poor treatment adherence; this phenomenon was not observed in any female patients.
Further research revealed that female fetuses in utero have a higher risk of transmission and are more susceptible to type I interferon (IFN-I) resistant viruses, which typically have a lower replication capacity. On the other hand, viruses transmitted to male fetuses are usually sensitive to IFN-I and have a higher replication ability. However, despite poor adherence to ART treatment, the viruses infecting male patients who achieved sustained virological suppression had a lower replication capacity.
The research team concluded that, considering early immunological gender differences, different immune interventions are crucial for optimizing the potential for curing HIV in children.
Reference:
- Cromhout, et al. Sustained aviraemia in the absence of anti-retroviral therapy in male children following in utero vertical HIV transmission. IAS 2023 Abstract OALBX0104 .
