New Delhi: A team of Indian doctors has reported the first known cases of children in India who may be naturally resistant to AIDS.

Although medical researchers have been looking at new ways to tackle the AIDS-causing HIV by exploring alternative drugs, an emerging approach is to find HIV patients who are naturally resistant to the disease, tease out clues of what allows them to stave off illness, and eventually develop a new vaccine.

To that end, researchers across the world have identified so-called elite controllers and long-term nonprogressors (LTNPs)—patients who are HIV-positive but remain healthy for several years. While there isn’t an iron-clad definition for these niche subsets of patients, experts say that those who are able to remain relatively healthy for at least 6-10 years are LTNPs, and elite controllers—a rarer subset—are able to ward off the disease for 20-25 years.

“LTNP have been described rarely in children across the world. This is perhaps the first report of LTNP in vertically transmitted HIV-infected children (contracting an infection from parents) from India," said Ira Shah, one of the doctors who reported the study in the latest edition of the peer-reviewed Indian Journal of Medical Research. “LNTPs constitute 5-15% of HIV-infected individuals in the world."

Elite controllers, experts say, constitute less than 2% of those who test HIV-positive.

In their report, the doctors said nine such children were identified from western India, and in spite of being diagnosed with the virus, didn’t require hospitalization or antiretroviral therapy.

The children ranged from between 9 and 13 years of age and had a CD4 count that exceeded 500. The CD4 count relates to the number of white blood cells that fight infection present in the blood. While healthy people maintain CD4 counts between 500 and 1,200, anything below 200 is generally categorized as leading to AIDS.

The discovery of the resilient Indian children comes on the back of reports of the recovery of an HIV-infected baby in Mississippi in the US who's now a toddler and believed to be completely cured of the ailment. Researchers said though preliminary, the child’s recovery could herald a new way of approaching vaccine and drug design for combating HIV infections.

In November 2011, Mint had reported on a project where the International AIDS Vaccine Initiative (IAVI), an agency that works on research and advocacy around HIV, and Chennai-based YRG Care were scouring the country to look for LTNPs and elite controllers.

Though such patients, too, eventually fall prey to infections, their relative resilience comes from having immune systems that produce a class of specialized, rare antibodies called broadly neutralizing antibodies (BNABs).

There are several antibodies that the immune system produces to fight infections, especially those that are viral in nature. However, the sheer diversity of HIV viruses, coupled with rapid mutation rates, means that most viruses escape detection by these antibodies.

BNABs are a smarter class of antibodies that are able to identify more weak spots on the offending virus’s surface and prevent it from targeting the immune system.

Thus far, only about 25 individuals from the US, Australia, Europe and Africa have been classified as elite neutralizers and there are still no confirmed reports from India.

“I haven’t read this report, but we are still in the process of looking for such candidates in India and should hopefully begin our analysis by the end of this year," said Rajat Goyal, country head, IAVI.

He added that LTNPs in India were valuable for science,, but that a lack of a standard definition in India on what constitutes an LTNP or controller meant it was difficult to know how many of the children would actually be controllers. The doctors said these children have avoided the disease from between three and six years.

Identifying Indian children who appeared to be resilient to AIDS was vital to vaccine development efforts, according to Anirrudh Sarkar, an immunologist at the University of Delhi.

“The particular strain of HIV virus commonly found in India is different from that in the West. Such a find, therefore, has potential local benefits to us," Sarkar said, adding that such an effort, however, wouldn’t be immediately useful to existing patients and “it would be a long time" before practical benefits could be realized.

Though a vaccine for HIV has eluded researchers, the rate of new HIV infections has been declining globally. In India, it has dipped from 274,000 in 2000 to 116,000 in 2011, said a report by the National AIDS Control Organisation.

The estimated number of people living with HIV was just over two million in 2011, the report said. It is estimated that about 148,000 people died of AIDS-related causes in that year in India. Deaths among HIV-infected children account for 7% of all AIDS-related mortality.

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