Brief Report

Approach to the management of paediatric HIV spontaneous controllers

Peter Zuidewind, Mark Cotton, Shaun Barnabas, Anita Janse van Rensburg, Gert van Zyl, Carli Gordijn
Southern African Journal of Infectious Diseases | Vol 37, No 1 | a399 | DOI: https://doi.org/10.4102/sajid.v37i1.399 | © 2022 Peter Zuidewind, Mark Cotton, Shaun Barnabas, Anita Janse Van Rensburg, Gert van Zyl, Carli Gordijn | This work is licensed under CC Attribution 4.0
Submitted: 13 January 2022 | Published: 30 June 2022

About the author(s)

Peter Zuidewind, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
Mark Cotton, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
Shaun Barnabas, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
Anita Janse van Rensburg, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
Gert van Zyl, Department of Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
Carli Gordijn, Department of Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa

Abstract

Paediatric HIV spontaneous controllers (HSCs) are a unique and understudied population with potential to inform alternative treatment options for patients living with HIV. As HSCs are so rare and often not recognised prior to antiretroviral treatment (ART) initiation, it can be difficult for clinicians to optimally manage this group. We describe the diagnosis, history and management of three paediatric HSCs, two girls and a boy who were followed for 2, 1.25 and 10.4 years, respectively, before starting ART. All had low but detectable viral loads throughout follow-up but mostly marginally low CD4:CD8 ratios. The reason for starting ART in all was a gradual tendency to poorer virological control. This case series should assist in recognising paediatric HSCs. Clinical dilemmas arising in the management of paediatric HSCs include arriving at a correct HIV-positive diagnosis, correct diagnosis as an HSC, as well as whether to initiate ART. Decision-making for initiation of ART in paediatric HSCs should be individualised. Factors supporting ART initiation in these patients included increased frequency of viral load blips, increasing detectable viral load, CD4 percentage and CD4:CD8 ratio. Other factors included Hepatitis C serology and highly sensitive C-reactive protein. All three patients ultimately required ART, which supports universal initiation of ART in paediatric HSCs, but further research is required.

 


Keywords

HIV; spontaneous controllers; paediatrics; HIV functional cure; infectious diseases

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