Web edition: March 4, 2013
Print edition: April 6, 2013; Vol.183 #7 (p. 14)
An infant born with HIV has cleared her body of the virus with the help of three medications started shortly after birth, scientists reported March 3 at the Conference on Retroviral and Opportunistic Infections in Atlanta.
On its face, the case looks like the first time an infant has ever wiped out the pathogen as well as the first time a person has been cured with drugs. The virus was thwarted in the girl, now 2 1/2 years old, with the help of more drugs than a newborn usually gets.
But some researchers caution that it remains unclear whether the virus had taken hold and infected the child or whether the child merely carried the virus from her mother.
“There’s no question the baby was exposed,” says Daniel Kuritzkes, a virologist at Harvard Medical School and Brigham and Women’s Hospital in Boston, who wasn’t involved in the case. “It’s a little less easy to determine whether the child was actually infected.”
Previously, the only person cured of HIV infection was a man in Berlin who vanquished the virus after getting a bone marrow transplant from a person with a specific gene mutation that makes cells resistant to the virus.
Either way, Kuritzkes says, the difference between “exposed” and “infected” might prove semantic if further research supports the idea of stopping childhood HIV by giving at-risk newborns the three antiretroviral drugs. The standard care starts with a preventive dose of one drug for a week and another for six weeks.
Virologist Deborah Persaud of Johns Hopkins University, who presented the data, and her colleagues suggest that prompt use of the triple therapy knocked out HIV in this child by intercepting the virus before it could create reservoirs in the body that are unreachable by drugs.
The mother of the Mississippi child was unaware until giving birth that she was infected and hadn’t been taking anti-HIV drugs during pregnancy. This lack of prenatal antiretroviral care, and a positive test for HIV in the mother and baby, prompted Hannah Gay, a University of Mississippi pediatrician who supervised the treatment, to prescribe a therapeutic triple therapy for the child as soon as possible, which turned out to be 30 hours after birth.
The baby’s blood continued to test positive for HIV at days 7, 12 and 20. But on day 29 a test came back negative. The baby stayed on the triple drug regimen until she was 18 months old, at which point the mother stopped bringing the baby in for doctor’s visits.
Several months later, the child was tested and found to be “functionally cured,” a term signifying that doctors were unable to locate any replicating HIV in her body. All that remained was viral fragments, even though the child hadn’t been receiving medication.
Whether the treatment used in the Mississippi child could serve as a model for therapy for newborns with HIV remains unknown. Mother-to-child HIV transmission has become uncommon in the United States, with perhaps 200 cases per year or fewer, thanks to preventive drug regimens during pregnancy and in newborns. It still occurs frequently elsewhere, with some 300,000 HIV-infected births every year.
"People are really quite intrigued by this report,” Kuritzkes says.
D. Persaud et al. Functional HIV cure after very early ART of an infected infant. 20th Conference on Retroviruses and Opportunistic Infections. Atlanta, Georgia. March 3-6, 2013. Abstract available: