A combination of three anti-retroviral drugs appears to have nearly completely eliminated HIV from a Mississippi infant born with the virus. This is the first “well-documented case of a functional cure” of HIV in a child, according to researchers and doctors who presented the findings at the 20th Conference on Retroviruses and Opportunistic Infections Researchers yesterday (March 4).
"We expect that this baby has great chances for a long, healthy life. We are certainly hoping that this approach could lead to the same outcome in many other high-risk babies," Hannah Gay, a professor of pediatrics and doctor at the University of Mississippi Medical Center where the infant was treated, told The Guardian.
In 2010, the child’s mother checked into a rural Mississippi hospital about to give birth prematurely, The New York Times reported. She had not previously sought medical care during her pregnancy. Usually women with HIV are given anti-retroviral drugs in pregnancy to prevent transmission to their child, but the woman had not known she harbored an HIV infection and so had received no treatment.
The child was transferred to the University of Mississippi Medical Center, arriving 30 hours after birth. Usually only one or two anti-retroviral drugs are administered to babies born to HIV-infected mothers. But Gay decided to immediately administer the full three-drug cocktail before confirming the child’s infection status because she judged the child to be at such high risk.
The child’s viral load decreased, but after 18 months, the mother stopped showing up at appointments. Gay asked the Mississippi state health authorities to look for the child, National Public Radio reported. By the time the mother and toddler returned to the hospital, the mother said it had been months since the child had taken the medication.
Gay expected the virus to have rebounded, but, to her shock, it was undetectable. She consulted other researchers to verify that the virus was indeed gone, including Deborah Persaud of the Johns Hopkins Children’s Center, lead author of the conference presentation. The scientists found traces of viral genes but it appeared that the child, indeed, no longer needed HIV treatment.
Gay and colleagues believe the treatment may have worked because it knocked down the HIV virus before it had time to establish a reservoir in the infant’s body. Completely eliminating HIV is generally difficult because the virus can lie dormant for long periods of time, unreachable by anti-viral medication.
The report could have implications for treating newborns suspected to be HIV-positive. While fewer than 200 infants are born in the United States each year with HIV due to administration of anti-retroviral drugs to HIV-positive women during pregnancy, far more babies in the developing world are born with the virus.
"Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns," Persaud told The Guardian.