US baby’s HIV 'functionally cured'

In a development that might represent a breakthrough in the treatment of the Human Immunodeficiency Virus and the deadly disease it causes, Acquired Immunodeficiency Syndrome (HIV/AIDS), a child treated by doctors in Mississippi was said to be “functionally cured” after being exposed to the virus during birth.

The child was given standard anti-retroviral (ARV) drug therapy within 30 hours of birth by specialists at the University of Mississippi Medical Centre. A series of sensitive blood tests performed on the child 29 days after birth revealed “progressively diminishing viral presence in the infant’s blood, until it reached undetectable levels.”

The research team behind this project included Johns Hopkins Children’s Centre virologist Deborah Persaud, University of Massachusetts Medical School immunologist Katherine Luzuriaga, and University of Mississippi Medical Centre paediatric HIV specialist Hannah Gay.

According to the team, the infant was now deemed “functionally cured,” a condition that occurs when a patient achieves and maintains long-term viral remission without lifelong treatment and standard clinical tests fail to detect HIV replication in the blood. However, it is likely that a minute amount of the virus remains in the body, and the researchers said they believed this was what happened in the case of the child described in their report.

Speaking to The Hindu, Peter Hotez, Professor of paediatrics, molecular virology and microbiology at Baylor College of Medicine in Houston, Texas, said the Mississippi results could represent “a restricted case for newborns exposed to the virus at birth or during gestation.”

He said in this case the infection was caught early, possibly even as the virus was still entering the baby’s system and then the doctors supplied the ARVs. “This is different to case where adults have been infected for some time,” he noted. While it might be possible to translate this strategy to adults as well, the difference was that most adults did not realise they were being infected and by the time they did, they were already highly infected.

Further, in adults, the virus could hide in many different parts of body, Dr. Hotez said, and the effect of ARVs was to suppress and slow the progress of the infection rather than act as a “sterilising cure,” which is a complete eradication of all viral traces from the body.

Dr. Persaud emphasised that the findings could however imply that “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.”

Dr. Gay, who personally treated the infant, put the study in context saying, “Prevention really is the best cure, and we already have proven strategies that can prevent 98 per cent of newborn infections by identifying and treating HIV-positive pregnant women.”

Timely targeted use

Her colleague Dr. Luzuriaga added, “Complete viral eradication on a large scale is our long-term goal but, for now, remains out of reach, and our best chance may come from aggressive, timely and precisely targeted use of antiviral therapies in high-risk newborns as a way to achieve functional cure.”

Dr. Hotez said that while the only documented case of an actual cure was that of an adult in Germany who had bone marrow transplant, there had been several such instances of “non-progressors” who had been exposed to the virus but seem “naturally resistant.”

While there was a lot of interest in this subset of patients, Dr. Hotez added, it was better to be cautious in terms of generalising these results.

He emphasised that this was just a single, anecdotal case, and not a “controlled randomised trial,” and so it was not certain whether this was a one-off victory or whether it could be applied more widely.