A conversation with Philip Goulder about the recent article ‘Sustained aviremia despite anti-retroviral therapy non-adherence in male children after in utero HIV transmission’. In this episode of To Immunity and Beyond, we discuss a prospective study of 284 children from KwaZulu-Natal, South Africa, who were treated very early with antiretroviral therapy (ART) after mother-to-child transmission of HIV. Unexpectedly, female fetuses were more susceptible to in utero transmission, but of 5 children identified who maintained undetectable levels of HIV despite unscheduled ART interruption, all were males. Distinct viruses were transmitted to males and females – females but not males being susceptible to type I interferon-resistant, low fitness viruses. These findings indicate the central role that early life innate immune sex differences play in HIV cure/remission in children.

Full article: Bengu, N., Cromhout, G., Adland, E. et al. Sustained aviremia despite anti-retroviral therapy non-adherence in male children after in utero HIV transmission. Nat Med 30, 2796–2804 (2024). https://doi.org/10.1038/s41591-024-03105-4