Setback in the Fight Against Pediatric HIV

For over two decades, Harvard infectious disease expert Roger Shapiro has been at the forefront of efforts to combat HIV in Botswana, a country that once faced HIV prevalence rates exceeding 30% in the 1990s. While progress has been significant—Botswana today has an adult infection rate of over 20% yet a dramatic decrease in HIV-related deaths—the challenge persists. The primary tool in this fight has been antiretroviral treatment (ART), which has saved countless lives.

Shapiro's work, initiated in 1999 under the mentorship of Max Essex and through the Botswana Harvard Health Partnership, has included extensive research on HIV's impact on maternal and child health. Currently, he is leading a groundbreaking trial exploring innovative ways to control HIV in children without lifelong treatment. The study investigates the use of a combination of three broadly neutralizing HIV antibodies (bNAbs), a promising development amid past vaccine failures.

This trial is unique in pediatrics, aiming to determine whether children can achieve HIV remission or control through antibody treatment alone. The research builds on previous findings that bNAbs might enable the immune system to better eliminate the virus, potentially leading to a cure or longer periods of treatment-free control.

However, recent funding cuts have cast a shadow over these advancements. In May, a five-year grant supporting the study was abruptly reduced as part of broader federal research budget cuts, affecting not only this project but several others in Botswana led by Shapiro. The reduction jeopardizes the progress made and threatens to set back pediatric HIV cure efforts by years.

The trial involves monitoring 12 children aged 2–9 who are living with HIV, with plans to expand to 41 participants. Due to funding limitations, the current goal is 30 children, and ongoing support is uncertain beyond March. Despite these challenges, Shapiro emphasizes the potential of this research to revolutionize HIV treatment, allowing some children to potentially discontinue ART and control the virus naturally.

Botswana's remarkable containment success is partly due to its effective prevention programs, which exceed the UNAIDS 95-95-95 targets, with high rates of testing, treatment, and viral suppression. Yet, the prospect of losing this momentum worries experts like Shapiro, especially as U.S. aid reductions alongside local efforts threaten to increase transmission risks.

Ultimately, the ongoing fight against HIV/AIDS in Botswana exemplifies the importance of sustained research and support. The possibility of a pediatric HIV cure offers hope, but setbacks like funding cuts highlight the need for continued global collaboration and investment in this critical area.

Source: https://medicalxpress.com/news/2025-08-setback-pediatric-hiv.html