HIV baby infected in womb is in long- term remission, doctors confirm
Doctors now have convincing
evidence that they put HIV into long-
term remission in a Mississippi baby
born with the Aids virus.
The case was reported earlier this
year but some doctors were sceptical
that the baby was really infected
rather than testing positive because of
exposure to the virus in her mother's
blood.
The new report, published online on
Wednesday by the New England
Journal of Medicine , makes clear that
the girl, now three, was infected in
the womb. She was treated with an
aggressive cocktail of antiretroviral
drugs and shows no active infection
despite stopping treatment 18 months
ago.
"We want to be very cautious here.
We're calling it remission because
we'd like to observe the child for a
longer time and be absolutely sure
there's no rebound," said Dr
Katherine Luzuriaga, an Aids expert
from the University of Massachusetts
who is involved in the child's care.
The US government's top Aids
scientist, Dr Anthony Fauci, director
of the National Institute of Allergy
and Infectious Diseases, agreed.
"At minimum, the baby is in a clear
remission," he said, after a scientist at
the institute conducted tests that
showed no active virus in the child.
"It is possible that the baby has
actually been cured. We don't have a
definition for cure as we do for
certain cancers, where after five
years or so you can be relatively
certain the person is not going to go
and relapse."
A US government-sponsored
international study starting in
January aims to test early treatment
in babies born with HIV to see if the
results in this case can be
reproduced.
HIV-infected mothers in the US
generally receive antiretroviral
therapy during pregnancy, which
greatly reduces the chances of them
passing on the virus to their babies.
But the Mississippi woman had no
pre-natal care and her HIV was
discovered during labour. Doctors
considered the baby to be at such a
high risk that they started the child on
three powerful medicines 30 hours
after birth, rather than waiting for a
test to confirm infection, as is usually
done.
Within a month, the baby's virus fell
to undetectable levels. She remained
on treatment until she was 18 months
old, when doctors lost contact with
her. Ten months later, when she
returned, they could find no sign of
infection even though her mother had
stopped giving the child Aids
medicines.
Only one other person is thought to
have been cured of HIV infection – a
San Francisco man who had a bone
marrow transplant in 2007, from a
donor with natural resistance to HIV,
and showed no sign of infection five
years later.
But unlike the bone marrow case, the
Mississippi baby has "no immune
mechanism we can identify that
would keep the virus in check", said
another study author, Dr Deborah
Persaud of the Johns Hopkins
children's centre, who helped to
investigate the case.
Dr Peter Havens, the paediatric HIV
chief at the children's hospital of
Wisconsin and a government adviser
on treatment guidelines, said the child
might have an undiscovered genetic
trait that helped her to manage the
virus.
"I'm just not convinced that her
dramatic response would be
replicable in a large population," he
said, adding that it was too soon to
recommend treating other high-risk
babies with such an aggressive
combination of drugs without more
research.
In the upcoming study, doctors plan
to give Aids medicines for at least two
years and watch for signs of
remission before suspending
treatment and seeing whether a
remission results.
The Mississippi case "did open
people's eyes further" about a
possible cure, Luzuriaga said. "We
might be able to intervene early and
spare children a lifetime of therapy.
That is the potential impact of this
case."
