Doctors in Mississippi are believed to have cured an infant of HIV by initiating high-dosage treatment with antiretroviral (ARV) drugs within hours after birth. If this treatment success can be replicated, doctors will likely begin giving infants at highest risk of HIV infection drugs as soon as possible.
The human immunodeficiency virus (HIV), hit the United States hard in the 1980s, causing unrest and upheaval in social, medical and research spheres. To this date, despite decades of research, we have not been able to find a cure.
The virus itself attacks the immune system, the very system that is supposed to offer us protection against pathogens. Once the virus has done considerable damage to the immune system, a person develops AIDS, or acquired immune deficiency syndrome. The virus can be transmitted through contact with four types of infected body fluids: blood, semen, vaginal fluid and breast milk. Children of HIV positive women are at risk of infection for quite a long time; the virus can be transmitted pregnancy, delivery or breastfeeding.
If a mother is not treated during pregnancy, there is a thirty percent chance she will transmit the virus to her fetus. To prevent this, doctors typically give pregnant HIV positive women HIV medication to lower the amount of virus they carry. This lowers the risk of transmission to the fetus.
In this particular case, the mother had not received HIV medication during pregnancy, as she was not diagnosed until soon before giving birth. Thus, her baby was at high-risk.
The baby was transferred to the University of Mississippi where she would have been given low-dosage medications according to typical standards for infants. Dr. Hannah Gay chose to administer high-dosage medications, instead.
Dr. Gay treated the child for fifteen months until mother and baby stopped coming to their appointments, what doctors call being “lost to follow up.” With the help of social workers, the child was found and brought back to the hospital a few months later. Dr. Gay was astonished when the child’s HIV tests showed no sign of the virus, especially since the child had not been receiving drugs for the past several months. The child is now 2.5 years old and still tests negative for HIV, although doctors plan to continue testing.
Doctors are calling this a “functional cure” of HIV. This means that the child’s viral load has become so low that standard tests no longer detect the presence of HIV in the blood.
This cure differs from the only other documented cure of HIV. Timothy Ray Brown was also declared “functionally cured” after he received a stem cell transplant from a person with a genetic mutation that causes HIV resistance. In July 2012, Brown had been off HIV treatment for five years. This type of cure has not been replicated in other patients, mainly because the chance of finding donor matches is so low.
In the case of the Mississippi baby, the cure is comparatively feasible since it involves HIV drugs that are readily available in many medical settings. Doctors have emphasized that the time at which treatment was given was key in this success. Dr. Deborah Persaud, a virologist at Johns Hopkins Children’s Center and lead author of the report explained, “Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place.”
Doctors hope to try replicating these results in controlled trials in the future. In a statement, the WHO reported that this finding “points to the potential need for earlier access to HIV diagnostics to infants born to HIV positive mothers.” However, they will not change their recommendations on ARVs for HIV positive mothers “until more information becomes available.”
If proven to be replicable, this cure could have huge positive impacts worldwide. It was estimated that 3.4 million children were living with HIV in 2011. This strategy could prove invaluable in the WHO, UNICEF, and UNAIDS goal of eliminating pediatric HIV by 2015.
The report on this case was presented on March 3 at the 20th Conference on Retroviruses and Opportunistic Infections in Atlanta by Deborah Persaud, M.D., and Katherine Luzuriaga, M.D.