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A 2-year-old
Mississippi baby has become the the first child to be “functionally cured” of
HIV, researchers announced Sunday.
Researchers said they believe early
intervention — in this case within 30 hours of birth — with three anti-viral
drugs was key to the outcome.
A “functional cure” is when the
presence of the virus is so small, lifelong treatment is not necessary and
standard clinical tests cannot detect the virus in the blood.
The
finding was announced at the 2013 Conference on Retroviruses and Opportunistic
Infections in Atlanta.
The
unidentified girl was born HIV-positive to a mother who received no prenatal
care and was not diagnosed as HIV-positive herself until just before delivery.
“We didn’t have the opportunity
to treat the mom during the pregnancy as we would like to be able do to prevent
transmission to the baby,” said Dr. Hannah Gay.
Gay, a pediatric HIV
specialist at the University of Mississippi Medical Center, told CNN the timing
of intervention in this case, before the baby was diagnosed HIV-positive, may
deserve “more emphasis than the particular drugs or number of drugs used.”
“We are hoping that future studies
will show that very early institution of effective therapy will result in this
same outcome consistently,” she said on the eve of the conference.
Dr. Katherine Luzuriaga, an
immunologist at the University of Massachusetts who worked closely with Gay,
called the developments fascinating, including the fact that the toddler was
found to have no virus in her blood even after her mother stopped giving her
treatment for eight to 10 months.
“This is the very
first case in which we’ve conclusively been able to document that the baby was
infected and then after a period of treatment has been able to go off treatment
without viral rebound,” Luzuriaga told CNN.
Because it was determined the
Mississippi mother was HIV-positive, once the baby was delivered, Gay
immediately began giving the infant antiretroviral drugs in an attempt to control
HIV infection.
“We started therapy as early as
possible, which in this case was about 30 hours of age,” the physician said.
“And because it was a high-risk exposure, I decided to use three drugs rather
than one.”
Within a couple of days, Gay confirmed
that the child was HIV positive. She says the baby had probably been infected
in the womb.
The
child remained on antiretroviral drugs for approximately 15 months. Her mother
then stopped administering the drug for some reason and care was resumed after
health officials intervened, Gay said.
Researchers
have long known that treating HIV-positive mothers early on is important, because
they pass antibodies on to their babies.
“One hundred percent
of (HIV-positive) moms will pass those antibodies, but in the absence of
treatment, only 30% of moms will transmit the actual virus,” Luzuriaga told
CNN.
HIV-positive
mothers given appropriate treatment pass the virus on in less than 2% of cases,
Luzuriaga said.
“So
all babies are born antibody positive, but only a fraction of babies born to
HIV positive women will actually get the virus, and that fraction depends on
whether the mom and baby are getting antiviral prophylaxis (preventative
treatment) or not,” said Luzuriaga.
Newborns are
considered high-risk if their mothers’ HIV infections are not under control or
if they are found to be HIV-positive when they’re close to delivering.
Usually,
these infants would get anti-viral drugs at preventative doses for six weeks to
prevent infection, then start therapy if HIV is diagnosed.
Investigators
say the Mississippi case may change that practice because it highlights the potential
for cure with very early standard antiretroviral therapy (ART).
ART
is a combination of at least three drugs used to suppress the virus and stop the
progression of the disease.
But
they do not kill the virus. Tests showed the virus in the Mississippi baby’s
blood continued to decrease and reached undetectable levels within 29 days of
the initial treatment.
Dr. Deborah Persaud, a
virologist with Johns Hopkins Children’s Center, was lead author on the report.
The early treatment likely led to the infant’s cure, she said.
“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,”
Persaud says.
Persaud and Luzuriaga
are part of a group of researchers working to explore and document possible
pediatric HIV cure cases. The group was funded by a grant from amfAR, the American
Foundation for AIDS Research, and the National Institutes of Health.
Dr.
Rowena Johnston, amfAR vice president and director of research, said it is
“imperative that we learn more about a newborn’s immune system, how it differs
from an adults and what factors made it possible for the child to be cured.”
Dr.
Anthony Fauci, director of the National Institute of Allergy and Infectious
Diseases at the National Institutes of Health, is enthusiastic about the
findings.
“The best way to
either eliminate the virus or allow the immune system to suppress residual
virus is to treat someone as early as possible after infection so as not to
allow a substantial reservoir of the virus to take hold,” Fauci told CNN.
“At the same time, you
prevent the immune system from being severely damaged by the continual
replication of (the) virus for an extended period of time,” he said. “The
situation with a child born of an infected mother where most of the infections
are transmitted to the newborn at or around the time of delivery provides an
excellent opportunity to cure an infected baby, and this approach deserves
further study.”
Researchers
say the only other documented case of an HIV cure is that of Timothy Brown, the
“Berlin patient.” In 2007, Brown, an HIV-positive American living in Germany,
was battling both leukemia and HIV when he underwent a bone marrow transplant
that cured not only his cancer but his HIV as well.
In
an interview last year, Brown told Dr. Sanjay Gupta, CNN’s chief medical
correspondent, he was still HIV-free.
“I’ve been tested
everywhere possible,” said Brown who now lives in San Francisco. “My blood’s
been tested by many, many agencies, I’ve had two colonoscopies to test to see
if they could find HIV in my colon, and they haven’t been able to find any.”
But Brown’s case is
rare. And, the procedure, which is extremely dangerous, won’t work in most
patients because the bone marrow he received had a special genetic mutation
that made the stem cells in it naturally resistant to the virus.
Researchers
tell CNN only 1% of Caucasians — mostly Northern Europeans — and no African-Americans
or Asians have this particular mutation.
Last
June, five years after he was “cured,” reports surfaced that “traces” of the
virus had been found in Brown’s blood.
Even
then, some HIV experts said that doesn’t matter, that he’s been cured. In fact,
many AIDS experts believe Brown has experienced what’s called a “sterilizing”
cure, meaning the virus has been eliminated from the body entirely.
Routine
clinical testing on the Mississippi toddler continues, Gay says. So far, there
is no evidence of the virus.
“On the
ultra-sensitive testing, we are occasionally getting signals so we cannot say
with certainty that this child is absolutely clear of HIV, but we will continue
to follow up with the baby,” Luzuriaga said. “We have formed a hypothesis and
that is already driving the design of new studies and clinical trials that will
help us to answer the question of whether by coming in very early we will be
able to treat children for a while and then remove them from therapy.”
Source: Saundra Young, CNN
The Friends of AIDS
Foundation is dedicated to enhancing the quality of life for HIV positive
individuals and empowering people to make healthy choices to prevent the spread
of the HIV virus. To learn more about The Friends of AIDS Foundation, please
visit:
http://www.friendsofaids.org.
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