For the first time in medical history doctors have announced they have effectively cured an infant of HIV, but is this the breakthrough it seems?
The Mississippi Baby: Now Living Life HIV Symptom Free
Scientists announced Sunday at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta that doctors working at the University of Mississippi have for the first time anywhere in the world managed to functionally cure a child of HIV.
While the identity of both the child and its mother have been kept a secret, the baby is now a happy and thriving toddler who continues to show no signs of HIV symptoms.
The child, dubbed the “Mississippi Baby” by the press, is expected to be able to live a healthy life without need for HIV treatment.
How Did Scientists Cure the Child?
According to reports, the child’s mother was unaware she had HIV until after a routine test conducted while she was in labor came back positive. This meant that she could not be given the standard medications that are used when HIV transmission is detected prior to labor. Subsequently, the baby’s risk of contracting HIV was significantly higher than doctors at the hospital would normally have encountered.
As such, once the baby had been delivered the medical staff decided on an aggressive approach. They began treating the child just 30 hours after birth and with three antiretroviral drugs rather than the usual standalone treatment.
Several days later blood tests showed that the child was indeed infected with HIV, something that had likely happened shortly before birth. Doctors continued treating the child, expecting that this would now mean the baby would require life-long HIV care.
A month later, to their surprise, they found the level of HIV in the baby’s blood was so low standard lab tests could not detect it. Regular clinic visits continued for the next year until the mother and child began missing appointments. They then ceased to attend the meetings altogether meaning that, from the age of 18 months, the child received no medical intervention to combat HIV. The child did not see doctors again until nearly two years of age.
Staggeringly, though the doctors had expected to see high levels of the virus in the child’s blood, none could be detected. Under closer examination via much more sensitive blood tests, doctors found only trace levels of the virus that were not capable of replicating. This is what is known as a “functional cure.”
Was the Child Actually Cured of HIV?
There have been protests that calling this a cure isn’t technically true.
If we want to be rigorous about our terminology (and there is good reason to be when it comes to HIV), the virus has not been eliminated in this case, but a “functional cure,” has been achieved. That means the child remains free of HIV symptoms and cannot transmit the virus. While the distinction doesn’t matter so much in terms of outcome, the child is likely to live a life free of HIV, the distinction is important for science.
Why? Well, the only other person on record to have been functionally cured of HIV is Timothy Brown, known as the Berlin Patient, whose HIV symptoms disappeared after a bone marrow transplant. Brown was again the subject of scientific interest last year when researchers announced that they had found trace amounts of the virus in Brown’s blood when before they had not been detectable. Brown remains functionally cured but further tests are being used to work out what this means for our understanding of his case and whether it is possible the virus could reassert itself (which seems unlikely but nevertheless must be explored).
In the same way, it will be important for doctors to understand the similarities in both cases, both involved effectively turning off HIV’s ability to replicate but were achieved through very different methods, and whether this points to other areas of research that could in time lead to a wider cure.
So yes, a cure has for all practical purposes been found but as to the question of whether this is the cure for HIV? No, not yet.
What Does This Mean For HIV Patients and HIV Prevention?
Well, at this juncture, not much. For adults living with HIV/AIDS the treatment that was used in this case will not be effective because the virus has already established the method by which it replicates itself and this treatment regiment would not help.
However, this case could potentially be a landmark in stemming the spread of HIV/AIDS when it comes to infant patients for whom this treatment could still be viable, but only if further tests and future trials prove that this case could be successfully replicated in clinics around the world.
Specifically, and rather than emphasizing the drugs used, the treatment window in this case has been heralded as the crucial factor. Usually, doctors would wait before starting a treatment regime for children with a positive HIV infection test. In this case, because doctors knew there was an overriding likelihood of transmission, they treated the Mississippi Baby within hours of the child being born.
The researchers believe that it was this act that stopped the virus from establishing its method of replication, and that this may have been key in the functional cure.
Obviously there is still much research to be done before any kind of further treatment ideas can be ventured, and those sounding notes of caution are being both responsible and pragmatic because we remain a long way away from establishing any kind of wide-ranging, easily deliverable cure, yet the case is undeniably encouraging.
Image credit: Thinkstock.
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