“Cured” woman is HIV-free for 12 years without taking drugs

A dozen years free of HIV without taking drugs. A young woman who was born with the virus has undetectable levels in her blood 18 years later. It is the first time a person who received treatment for HIV as a baby and then stopped has had such a long remission from the virus.
The young woman’s mother had HIV, and she herself was diagnosed with the virus when she was a month old. She was then started on a course of antiretroviral drugs to stop it from replicating. She continued to take these for just under six years, at which point her family decided to end her treatment.
When doctors tested her a year later, they were unable to detect the virus in her blood and decided not to resume treatment. Eleven years on, the woman still has undetectable levels of the virus in her blood – the longest anyone diagnosed with HIV as a child has remained virus-free without drugs.

The woman has no genetic factors that might make her naturally resistant to the virus. Instead, it is likely that the early, regular use of a combination of antiretroviral drugs is to credit for her remission, says Asier Sáez-Cirión of the Pasteur Institute in Paris, France, who will present the case at the International AIDS Society meeting in Vancouver, Canada, on Tuesday.
Scott Sieg at Case Western Reserve University in Cleveland, Ohio, thinks it is an exciting observation. “There have been other reports of treating infants followed by stoppage of antiretroviral therapy that have not turned out as well,” he says. “This case provides new hope.”

Control or cure?

Has this young woman been cured?
When a person is infected with HIV, the virus not only courses through the bloodstream, but takes up permanent residence in certain cells, such as those in the gut. Although the virus can be targeted in the blood with antiretroviral drugs that stop it from replicating, HIV can remain hidden inside cells. In this case, there are no detectable levels of the virus in the woman’s blood after 12 years without drugs – in other cases this has been described as a “functional cure” because HIV is no longer circulating . But that doesn’t rule out the possibility that HIV is still hiding away in some of her cells.
Does that mean there is a chance her HIV could return?
Unfortunately, yes. “We’ve seen in the past that relapses can occur after years of undetectable virus,” says Scott Sieg of Case Western Reserve University in Cleveland, Ohio. As long as HIV remains in a single cell, there is a chance that the virus can be reactivated, he says.
People have been declared functionally cured before. What is special about this case?
A handful of people have been declared functionally cured of HIV. One group of adults appear to have remained so for about 10 years so far, without relapsing yet. Known as the Visconti cohort, they were treated with antiretroviral drugs shortly after they were infected. But the new case is the first time similar effects have been achieved when starting treatment during childhood. “We provide the proof of concept that long-term remission is possible in children, as in adults,” said lead researcher Asier Sáez-Cirión, of the Pasteur Institute in Paris, France, in a statement.
Will this case change how we treat HIV?
Babies born to women with HIV are already treated with antiretroviral drugs as standard, says Deborah Persaud at Johns Hopkins Children’s Center in Baltimore, Maryland. But almost every single one will relapse with the virus as soon as their treatment is stopped. The current case hints that there may be other ways yet to be discovered in which some individuals are protected from HIV, she says.