Five children see HIV viral loads vanish after taking antiretroviral drugs

For years, Philip Goulder has been obsessed with a particularly captivating idea: In the hunt for an HIV cure, could children hold the answers?

Starting in the mid-2010s, the University of Oxford pediatrician and immunologist began working with scientists in the South African province of KwaZulu-Natal, with the aim of tracking several hundred children who had acquired HIV from their mothers, either during pregnancy, childbirth, or breastfeeding.

After putting the children on antiretroviral drugs early in their lives to control the virus, Goulder and his colleagues were keen to monitor their progress and adherence to standard antiretroviral treatment, which stops HIV from replicating. But over the following decade, something unusual happened. Five of the children stopped coming to the clinic to collect their drugs, and when the team eventually tracked them down many months later, they appeared to be in perfect health.

“Instead of their viral loads being through the roof, they were undetectable,” says Goulder. “And normally HIV rebounds within two or three weeks.”

In a study published last year, Goulder described how all five remained in remission, despite having not received regular antiretroviral medication for some time, and in one case, up to 17 months. In the decadeslong search for an HIV cure, this offered a tantalizing insight: that the first widespread success in curing HIV might not come in adults, but in children.

At the recent International AIDS Society conference held in Kigali, Rwanda, in mid-July, Alfredo Tagarro, a pediatrician at the Infanta Sofia University Hospital in Madrid, presented a new study showing that around 5 percent of HIV-infected children who receive antiretrovirals within the first six months of life ultimately suppress the HIV viral reservoir—the number of cells harboring the virus’s genetic material—to negligible levels. “Children have special immunological features which makes it more likely that we will develop an HIV cure for them before other populations,” says Tagarro.