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Economic Times
05-08-2025
- Health
- Economic Times
Promising HIV cure could be achieved through children: Decade long tests reveal
Cure for HIV emerges in children with early antiretroviral treatment New evidence from global HIV research suggests that the first widespread cure for HIV may be possible in children who receive antiretroviral therapy (ART) early in life. Pediatrician and immunologist Philip Goulder from the University of Oxford, working with researchers in South Africa, found that a small subset of HIV-infected infants treated soon after birth can suppress the virus to undetectable levels and maintain remission without ongoing medication for extended periods. After tracking several hundred children infected through mother-to-child transmission, Goulder's team was astonished to find five children who had stopped ART yet showed no viral rebound even after months off medicine, defying the typical two to three weeks it takes for HIV to return when treatment is interrupted. One child maintained remission for an unprecedented 17 months. These children's immune systems appear uniquely capable of controlling HIV independently, a phenomenon not seen in adults despite decades of research. According to Alfredo Tagarro, a pediatrician at the Infanta Sofia University Hospital in Madrid, children living with HIV have often been overlooked in the effort to develop treatments that can achieve permanent remission. Since 2007, about 10 adults are believed to have been cured of HIV through stem cell transplants intended to treat life-threatening blood cancers. While these procedures successfully eradicated the virus, their complexity and significant risks—including several patient deaths—make them an impractical approach for targeting HIV specifically. At the 2025 International AIDS Society conference in Kigali, additional data showed approximately 5% of HIV-positive children initiating ART within six months of birth could reduce the viral reservoir—genetic material of the virus hidden in cells—to negligible levels. Pediatric experts attribute children's more dynamic immune systems and fewer health complications as factors that may enable this early cure. Mark Cotton of the University of Stellenbosch emphasized children's suitability for curative therapies compared to adults with comorbidities. Building on these insights, Goulder has launched a new study involving 19 South African children who have suppressed HIV reservoirs under ART. He plans to carefully discontinue treatment and monitor how many keep the virus suppressed long-term. Early results show six children maintaining remission for more than 18 months without drugs. Boys may have an immunological advantage in controlling HIV due to innate immune system experimental treatments are also being explored in children, including gene therapy designed to make muscle cells continuously produce broadly neutralizing antibodies (bNAbs). This one-time therapy could protect infants in high-prevalence regions by preventing HIV transmission from birth or breastfeeding. Research in newborn monkeys highlights a critical early window post-birth when gene therapy is most effective, potentially revolutionizing pediatric HIV care in resource-limited recent funding setbacks, researchers remain optimistic. Combining ART with bNAbs, vaccines, and gene therapies may jointly corner and eliminate the virus, similar to successful pediatric leukemia treatments. While children represent a minority of global HIV cases, a cure in this group could provide the blueprint for universal HIV eradication global impact could be profound: about 1.7 million children worldwide live with HIV, many in low-income countries where lifelong ART adherence is challenging. An effective cure would drastically reduce the health and social burdens of pediatric HIV and pave the way for transforming HIV from a chronic condition into a curable breakthrough marks a historic turning point in the decades-long fight against HIV, with children potentially leading the route to a cure and offering hope for millions affected worldwide.
Medscape
31-07-2025
- Health
- Medscape
New Biomarker May Predict Advancement to HCC in HIV/HCV
Individuals living with both HIV and hepatitis C virus (HCV) who ultimately developed hepatocellular carcinoma (HCC) showed greater suppression of plasma extracellular vesicles (pEVs) after HCV clearance than those who did not develop cancer, based on new data presented at the International AIDS Society Conference on HIV Science. The study is important because of the persistent risk for HCC among individuals with advanced fibrosis who clear HCV with direct-acting antivirals, said Ariel Osegueda, MSc, a PhD candidate and biologist at the University of Buenos Aires, Buenos Aires, Argentina, in an interview. pEVs are essential in immune modulation. Natural killer (NK) cells are essential for immune surveillance, particularly in targeting tumor cells, and CD107a (also known as lysosomal-associated membrane protein-1) is an indicator of cytotoxic activity. 'Understanding how natural killer cell function is modulated in this context may reveal mechanisms linked to that increased risk,' said Osegueda, who presented the findings at the meeting. The researchers collected plasma samples from 11 adults with advanced liver disease at baseline and after treatment with direct-acting antivirals. A total of five patients developed HCC after a median of 5.75 years after clearance. The researchers also assessed samples from six healthy control individuals. NK cell degranulation was assessed using flow cytometry. The pEV from individuals with advanced LF at baseline were significantly more suppressive than control individuals (0.71 vs 0.88; P = .023). By at least 1 year after direct-acting antiviral therapy, pEV in patients who developed HCC was significantly more suppressive than in those who did not develop HCC (0.75 vs 0.86; P = .008). In addition, the pEV among individuals who did not develop HCC was similar to control individuals, whereas pEV from those who ultimately developed HCC was more suppressive than control individuals ( P = .03). Overall, the presence of pEV from all study participants, including control individuals, reduced expression of NK CD107a expression compared to NK cells without pEV. NK suppression persisted over time in patients who developed HCC but decreased in those who did not. The researchers were particularly surprised by the persistent NK suppression seen in patients who developed HCC, Osegueda told Medscape Medical News . 'This suggests an early and lasting immune alteration not reversed by viral clearance,' she said. This study was limited by the small sample size, but there are implications for clinical practice, Osegueda said. 'Persistent NK dysfunction mediated by plasma extracellular vesicles could become a biomarker to identify patients at higher risk of hepatocellular carcinoma after HCV cure,' she said. However, larger studies are needed to confirm these findings, characterize the pEV content, and explore whether modulating NK function can reduce HCC risk, Osegueda added. Foundation for Future Studies 'The risk of HCC remains elevated for patients living with HIV who have liver fibrosis despite HCV cure,' said David J. Cennimo, MD, associate professor of medicine and pediatrics in the Division of Infectious Disease at Rutgers New Jersey Medical School, Newark, New Jersey, in an interview. In the current study, the researchers present early data that could help identify a risk factor for liver cancer, said Cennimo, who was not involved in the study. The study also sheds light on the impact of the immune system's surveillance in preventing cancer by closer examination of pEVs, he said. This study was funded by a grant from the National Agency for Research, Technological Development and Innovation (Argentina). The authors had no financial disclosures.
Medscape
28-07-2025
- Health
- Medscape
WHO Urges Rapid Treatment for Concurrent HIV and Mpox
People living with HIV who contract mpox should start antiretroviral therapy (ART) as soon as possible, according to updated recommendations from the World Health Organization (WHO). People living with HIV are disproportionately infected by mpox and experience more severe disease and higher rates of death than individuals who develop mpox but do not have HIV, said Remco Peters, MD, medical officer of the WHO, who presented the updated guideline at the International AIDS Society Conference on HIV Science. The standard of care calls for initiation of ART within 7 days of an HIV diagnosis, Peters said in his presentation. Some concerns have been raised about the risk for immune reconstitution inflammatory syndrome associated with mpox, but data are limited, Peters said. However, the guideline developers focused on the 'very clear benefits of direct entry to viral therapy in general for people living with HIV,' he said. Without entry to biotherapy, individuals with low CD4 counts in particular (defined as < 200 cells/mm3) are at greater risk for severe disease and death from mpox, and early treatment of HIV is even more important in this population, given the lack of a specific treatment for mpox, Peters said in his presentation. Consequently, the WHO's strong recommendation, based on moderate certainty of evidence, calls for rapid ART initiation in people with HIV and mpox who are ART-naïve or who have had an extended interruption in ART treatment. In practice, this means that early HIV testing should be conducted when patients present with presumptive or confirmed mpox, said Peters in his presentation. Patients should be referred for ART as soon as possible, including an offer of same-day start, with the goal to provide therapy within 7 days, he said. The guideline also states that people already on ART should continue their therapy if they contract mpox, Peters emphasized. For people already on ART but with an undetectable viral load, ART regimens should be continued without interruption or change, while those with detectable viral loads should be managed accordingly, he added. The guidelines for management of mpox align with the WHO's broader guidance for rapid treatment initiation in new cases of HIV, according to the WHO's press release.
Medscape
22-07-2025
- Health
- Medscape
Healthcare Access, Geography Predict HIV in Black Women
Limited healthcare access and sociostructural factors were stronger predictors of HIV than behavioral risk factors among Black women in the southern United States, based on modeling data from more than 300,000 women in or near Atlanta, Georgia. The findings were presented in a late-breaker study at the International AIDS Society Conference on HIV Science. Nonbehavioral factors such as structural and social determinants of health can complicate HIV risk assessment, wrote Meredith Lora, MD, of Emory University, Atlanta, and colleagues. Previous risk prediction models have underperformed in Black women, whose HIV risk is approximately 20 times that of White women, the researchers wrote. To better assess HIV risk in Black women, the researchers used machine learning to create a model that analyzed electronic medical records data from all women treated at a single center in Atlanta between 2012 and 2022. The study population included 333,263 women; 617 (0.19%) had incident HIV diagnoses and 89% of those with HIV identified as Black individuals. The model included features with a prevalence of 5% or higher in the electronic medical records data and included novel structural determinant features and healthcare utilization features. Overall, the top predictors of HIV included younger age, Black race, residing in high HIV incidence zip codes, and at least one change in phone number or address prior to HIV diagnosis. In addition, women who underwent more HIV screening tests were more likely to be diagnosed with HIV, and women with HIV were more likely than those without HIV to seek care in an emergency department (ED) vs primary care or women's healthcare settings. Although more women with HIV tested positive for sexually transmitted infectious compared to those without HIV in the 2 years before diagnosis, 'seeking sexual health was more important to the model than STI positivity,' the researchers wrote. The model achieved a test area under the receiver operating characteristic curve (AUROC) of 0.90 and area under a precision-recall curve (AUPRC) of 0.14. The appearance of frequent HIV testing as a predictor of risk suggests the presence of undisclosed risk factors that may merit further investigation, the researchers noted in their abstract. EHR models designed for racially diverse female populations may identify more candidates for pre-exposure prophylaxis (PrEP), but that is not enough, the researchers emphasized. 'Evaluating how these models are implemented to support PrEP uptake and behavior change is critical for real-world impact,' they concluded. Assistance in Risk Assessment The current study is important given the traditional and historical difficulty of women in the United States in predicting their own risk of HIV, said Monica Gandhi, MD, director of the University of California San Francisco Bay Area Center for AIDS Research, and a professor of medicine at UCSF, in an interview. Gandhi cited a recent study from the CDC showing that more than 2.2 million individuals in the US need PrEP, but only 336K have received prescriptions. 'Women may not be able to adjudicate their own risk of HIV, as that risk depends on the risk in their male sexual partners,' said Gandhi, who was not involved in the current study or the CDC study. 'Machine learning using electronic medical records [EMR] can make risk prediction more accurate by reporting both health and social factors,' she noted. The current study identified predictors of HIV risk using extracted EMR data, that the healthcare system may be able to mitigate, she said. 'I was surprised by the fact that seeking sexual health was a stronger predictor of HIV than STD positivity, which indicates that women actually are more aware of their risk for HIV in the US than suggested in previous studies that usually involved smaller sample sizes, Gandhi told Medscape Medical News . 'I was also surprised that women with frequent changes in address or phone number had higher risk,' she said. This suggests mobility as a risk factor, which has been identified more commonly in sub-Saharan Africa, she noted. However, Gandhi was not surprised by the preference for ED care or the increased HIV risk among Black women vs other races, both of which have implications for HIV prevention, she said. The preference for sexual health care in the ED setting in the study population suggests that the ED is an important setting in which to perform STD testing and start PrEP or set up an individual with HIV prevention services, said Gandhi. 'Designated PrEP services for women in historically Black neighborhoods are indicated, and women who are mobile and change their address or phone number frequently should be counseled on HIV prevention modalities, specifically PrEP,' she added. Looking ahead, qualitative research is needed to ask a subset of women with HIV who presented to the ED for sexual health services why they chose the ED; this could help inform how to re-engage women in care, Gandhi said. Additional research on women's knowledge of PrEP and whether women with HIV were offered PrEP in the past also would help identify more opportunities for HIV prevention, she said.
IOL News
21-07-2025
- Health
- IOL News
South Africa's HIV Response: Hope, Tools, and Resolve
South Africa has the world's largest HIV treatment programme, with over 5.5 million people receiving antiretrovirals (ARVs). Yet we still see more than 100 000 new HIV infections each year. That is unacceptable — and preventable. Image: Tumi Pakkies/ Independent Newspapers Earlier this month, more than 3,600 scientists, activists, policymakers, and journalists gathered in Kigali, Rwanda, for the 13th International AIDS Society (IAS) Conference on HIV Science. It was the first time this major global event took place in an African city outside South Africa, marking a powerful recognition of the continent's critical role in the global HIV response. The conference came on the heels of deeply concerning news: in January, the US government announced sharp cuts to funding for the President's Emergency Plan for AIDS Relief (PEPFAR), a move that cast a long shadow over the global fight against HIV, particularly in Africa. The numbers are staggering: of the 40.8 million people living with HIV globally, over 26 million (65%) are in Africa. And more than half of all new infections in 2024 occurred on the continent. A Call to Stay the Course Despite fears about reduced funding, the mood in Kigali was one of resolve. Delegates affirmed their commitment to ending HIV, recognising the extraordinary progress made in Eastern and Southern Africa. Many echoed a common sentiment: "We cannot stop now. We must fight to the end", emphasising the need for sustained commitment and effort to achieve an AIDS-free future. That optimism was reinforced by encouraging developments. The pharmaceutical company Gilead announced that Lenacapavir, a new HIV prevention drug administered via two injections a year, has shown high efficacy in clinical trials. If made widely accessible, this could be a game-changer— especially for those who struggle with daily pill regimens. Further hope came when the US Congress ultimately approved continued PEPFAR funding, although uncertainties remain around the duration and scope of future support. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Next Stay Close ✕ Ad loading What This Means for South Africa South Africa has the world's largest HIV treatment programme, with over 5.5 million people receiving antiretrovirals (ARVs). Yet we still see more than 100 000 new HIV infections each year. That is unacceptable — and preventable. To address this, the government launched the '1.1 Million Campaign' in February to close the gap between those who know their HIV status and those who are virally suppressed. But for this initiative to succeed, we need national mobilisation. Every political leader, community organiser, religious institution, and employer must actively support the campaign. Unfortunately, media coverage has been limited, and public awareness remains low. Doing More with Less With reductions in funding from the Global Fund and PEPFAR, and despite increased domestic investment, every rand in our HIV response must count. Managers and community activists in the health and social development sectors must track data rigorously: Who is being tested? Who is on treatment? Who is virally suppressed? Who is using Pre-Exposure Prophylaxis (PrEP) — and who should be, but isn't? We must also stand firm against stigma. There is no justification for discrimination against people living with HIV or those using preventive treatments like PrEP. They are taking responsible steps to protect themselves and others. They should be commended and supported, not shamed. The Tools Are in Our Hands We now have powerful tools to fight HIV. HIV self-test kits are available free at public clinics and affordable at private pharmacies. Oral PrEP— a once-a-day pill to prevent HIV — is also free at government health facilities. And injectable PrEP, which could significantly improve adherence, is expected to be available next year. Condoms remain a highly effective prevention method. Let's not forget—they also prevent sexually transmitted infections like syphilis and gonorrhoea and help avoid unplanned pregnancies. They are free at all public clinics. Let's also remember the link between HIV and tuberculosis (TB). People with HIV are more susceptible to TB. If you have symptoms or have been in contact with someone with TB, get tested. Early detection saves lives. Health Is Everyone's Business Building a healthier South Africa is not just about medicine—it is about national prosperity. A healthy population is more productive, more resilient, and more able to seize economic opportunity. Each of us has a role to play in protecting our health and the health of our communities. Let's work together to end HIV. The finish line is in sight—but only if we don't stop now. Prof Yogan Pillay is the Director for HIV and TB delivery at the Bill & Melinda Gates Foundation. He was previously the Country Director of the Clinton Health Access Initiative in South Africa and senior director for universal health coverage. He has worked in various capacities at the National Department of Health. In 2021, the University of Cape Town awarded him an honorary doctorate, and in the same year, he was appointed extraordinary professor in the Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University. Foster Mohale is the National Department of Health Spokesperson
