HIV has resurfaced in a child who was presumed cured of the virus. The discovery spotlights limits in detecting the clandestine germ and raises questions about whether HIV can ever truly be cured, experts say.
The child was born HIV-positive in 2010 and received treatment with standard antiretroviral drugs. The patient’s therapy was unexpectedly interrupted 18 months later. But the virus didn’t return to detectable levels, leading scientists to declare last year that the child was “functionally cured” (SN: 4/6/13, p. 14).
On July 10, researchers at the U.S. National Institute of Allergy and Infectious Diseases announced that the virus had resurfaced in the child’s blood after nearly four years of dormancy.
“What we’ve learned is that you can never be fully certain of HIV eradication,” says Daniel Kuritzkes, a Harvard virologist, who wasn’t involved in the case.
He explains that surveillance tools lack the sensitivity needed to find HIV in its many hideouts (SN: 7/26/14, p.12). The virus lives in immune cells called memory T cells that circulate in the blood. Doctors can easily collect and scan these cells for HIV. But
memory T cells also filter into lymph nodes or deep into organs, where the cells become inactive and HIV becomes invisible to standard detection. The virus waits until the T cell reawakens, at which point HIV once again replicates using the cell’s machinery.
Memory T cells live as long as eight years, so the potential for viral reemergence always existed for this child, says Marc Foca, an HIV specialist at the Morgan Stanley Children’s Hospital in New York City. “Most experts weren’t fully convinced that this baby was actually cured,” he says.
The child has gone back on antiretroviral treatment, and her viral levels have dropped.