HIV Cure Research in Children
For quite some time, Philip Goulder has been intrigued by a compelling question: could children provide clues in the search for an HIV cure?
Since around the mid-2010s, Goulder, a pediatrician and immunologist from the University of Oxford, has collaborated with researchers in KwaZulu-Natal, South Africa. Their focus was on a group of children infected with HIV from their mothers during pregnancy, delivery, or breastfeeding.
After starting these children on antiretroviral drugs early on to manage the virus, Goulder and his team were interested in observing their progress and adherence to the treatment. Over the years, however, an unexpected development occurred. Five of the children didn’t return to the clinic for their medications, and when the team managed to track them down months later, they seemed to be in excellent health.
“Instead of having high viral loads, they were undetectable,” Goulder remarked. “Typically, HIV rebounds within two to three weeks.”
In a study released last year, Goulder noted that all five children remained in remission, despite having gone without regular antiretroviral medication for extended periods—one for as long as 17 months. This revelation suggested that the first significant achievement in curing HIV might come from curing children rather than adults.
At a recent International AIDS Society conference in Kigali, Rwanda, pediatrician Alfredo Tagarro presented new findings indicating that approximately 5 percent of HIV-infected children treated with antiretrovirals in their first six months can significantly reduce the HIV viral reservoir—those cells that hold the virus’s genetic material—to near-zero levels. “Children possess unique immunological characteristics that may lead to the development of an HIV cure for them prior to other demographics,” Tagarro asserted.
This view was supported by Mark Cotton, who leads the children’s infectious diseases clinical research unit at the University of Stellenbosch in Cape Town. “Kids have a much more adaptable immune system,” Cotton highlighted. “They also lack complications like high blood pressure or kidney issues, making them more promising candidates for a cure.”
Tagarro pointed out that children with HIV have historically been overlooked in the quest for lasting treatments. Since 2007, about ten adults have reportedly been cured through stem cell transplants aimed at treating serious blood cancers—these procedures coincidentally eradicated the virus. However, due to the complexity and risks involved, these methods aren’t seen as practical for targeting HIV specifically.
Instead, like Goulder, pediatricians have increasingly realized that a small group of children who begin antiretroviral treatments early in life can often suppress HIV for extended periods, possibly even indefinitely, through their immune responses alone. This understanding grew from isolated case studies, such as the “Mississippi baby” who managed to control the virus for over two years without medication, and a South African child who maintained remission for more than ten years. Cotton estimates that between 10 and 20 percent of all HIV-infected children might control the virus for a substantial time after discontinuing antiretrovirals—far beyond the usual two to three weeks.
