Last year at this time, doctors in Mississippi announced that they had cleared a two-year-old girl born with HIV of the virus by giving her high doses of anti-retroviral drugs within 30 hours of her birth. Now, details of another case—this time in Long Beach, California—have been released at an AIDS conference; doctors say that once again HIV has become undetectable in the blood of a small child. Doctors in the new case followed the protocol set in Mississippi, and many experts are finding the results to be promising.
Anti-retroviral therapy (ART) can suppress HIV to the point that the virus becomes virtually undetectable in a person’s blood. This treatment allows people with HIV to stay healthy for years and even decades, but it cannot be considered a cure because once a person stops taking his or her medications the virus quickly reappears in their blood. Scientist have discovered what they call “HIV reservoirs,” cells that hold the genetic code of HIV but are dormant and invisible to the immune system and drug regimes. These cells hide in the brain, bone marrow, genital tract, and other places in the body. If individuals stop taking their drug cocktails, the reservoirs are likely to become active and HIV can start replicating itself again.
When the Mississippi baby stopped taking her medication, however, the virus did not return. The infant’s mother received no prenatal care and did not know that she herself was infected when she had the baby. Doctors tested the baby’s blood after delivery and declared that she was HIV-positive. They put
the baby on high doses of anti-retroviral drugs within 30 hours of her birth and she remained on this type of medication for about 18 months. Had the baby continued to be brought to her appointments, doctors would have kept her on the medication indefinitely, but she was lost to the system for almost six months and was not given her drugs during that time. Doctors were shocked when she returned and they realized that despite this absence of treatment she was for all intents and purposes free of the virus. They speculate that efforts to eradicate HIV from the body, which have never truly been successful in adults, may be possible in infants because treatment begins before HIV reservoirs are built. The Mississippi infant, now three years old, remains virus-free despite being off of all medications. Some experts question whether she was ever HIV-positive or if, instead, “the positive tests simply registered small amounts of the virus that had spilled over from the mother’s bloodstream during delivery.” Because they did not expect her to become a breakthrough case, her physicians did not save her blood and no new testing can be done, but they are convinced she was HIV-positive.
The Long Beach case provides some confirmation that this approach works, although the child, who is now nine months old, remains on her medications. The infant’s mother arrived at Miller Children’s Hospital in labor. She was mentally ill and had advanced AIDS, and though she had been given a prescription for anti-retroviral drugs that could have prevented her from infecting her fetus, she had not taken them. Physicians tested the child for HIV four hours after she was born, and both RNA and DNA for the virus were present in her spinal fluid and blood. They are convinced she was truly infected.
Following the Mississippi protocol, doctors gave the baby high doses of three drugs used to suppress the virus immediately after birth. They then tested her blood extensively and found that the virus began to disappear after six days and was completely gone by day 11. This baby cannot be considered “cured” or even in remission, however, because she continues to take her medications. Despite the potential success in these two cases, it would be unethical to take the child off the drugs in order to see if HIV comes back. Her physicians say that if she remains virus-free as of the age of two, they might consider taking her off the drugs for a period of time to see what happens. In the meantime, they have run the most sensitive blood tests available and can find no virus that is capable of replicating. Her lead physician told the New York Times that she describes the baby as “having sero-reverted to HIV-negative.”
The truth is that science has in many ways solved the problem of mother-to-child transmission of HIV. Had these mothers received adequate prenatal care (and taken their prescribed drug regimens), HIV infection in their infants could have been prevented and there would have never been a need to eradicate their bodies of the virus. In the United States, most pregnant women get the medication they need, but worldwide the number is only at 60 percent. These two cases, therefore, potentially provide a roadmap for “curing” babies who are born HIV-positive.
New studies are being planned to further test this concept. For example, a clinical trial set to begin soon will put up to 60 babies born HIV-positive on a drug regimen within 48 hours of birth to see if they, too, become virus-free. Dr. Anthony S. Fuaci, executive director of the National Institute for Allergy and Infectious Disease, told the New York Times that these results are important. “This could lead to major changes for two reasons,” he said. “Both for the welfare of the child, and because it is a huge proof of concept that you can cure someone if you can treat them early enough.”
Of course, with adults it is very hard to pinpoint the exact moment of infection and know what really is early enough.