Posted Monday, March 11, 2013
Aadia Rana, MD
The news continues to make international headlines: A Mississippi baby born with HIV has apparently been cured of the disease. Aadia Rana, MD, an infectious disease specialist at The Miriam Hospital, collaborates with the pediatric HIV specialist who treated the child on research involving linkage and retention in care among postpartum women in Mississippi. She offers her insight on this remarkable medical breakthrough.
My colleague at the University of Mississippi Medical Center, Dr. Hannah Gay, quickly started the baby on full anti-HIV medications within the first 30 hours of her birth. The infant was found to have the virus in her blood several times, but after being on therapy for several weeks, there was no evidence of the virus in her blood as is expected to happen for someone on treatment. Unfortunately, when the baby was about 18 months old, the mother stopped bringing the infant to her appointments. They tracked her down five months later and discovered the child’s HIV blood test showed no evidence of the virus! Dr. Gay involved researchers at the University of Massachusetts and Johns Hopkins and the tests were repeated using very sensitive methods, and they did not find any actively reproducing virus.
The researchers are terming this case a ‘functional cure.’ This definition is used when standard tests are negative for the virus, but it is likely that a tiny amount remains in their body though there is no evidence it is actively reproducing at this time. This is the case with this child, even though she has been off of medicine for more than one year now.
We are not exactly sure why, but one of the theories is that the child received therapy with full anti-HIV medications – three medications instead of one – very quickly after the virus was introduced into her blood, and the drugs eliminated the virus before it could infect ‘deeper’ cells that function as hideouts for the virus. This is why adults and older children aren't cured of HIV even when they are taking anti-HIV medications – there is still evidence of the virus in these hideout cells.
I think this case brings up some important questions regarding treatment
of possible HIV infection in the early stages, particularly with regard
to an infant’s immune system. Children infected with HIV are given drugs
with the intent to treat them for life, and anyone who takes the drugs
must remain on them. It is far too early and there are still too many
unanswered questions for anyone to try stopping therapy just to see if
the virus comes back.
The most reliable way to stop babies from contracting the virus from infected mothers is by identifying and treating HIV-positive women. In the U.S., these strategies prevent 98 percent of newborn infections. It is the women who are not identified as HIV-infected or do not receive therapy who are at highest risk for transmitting the virus to their baby – like in this case.
Currently, when an infant is presumed infected with HIV, the plan is to give the child lifelong medications to keep the virus under control. With this case, the next step would be to find out if this was an unusual response to very early HIV therapy, or a finding that can actually be shown in other high-risk newborns. If that is the case, there may be opportunities for functional cure in other infants who are treated with full anti-HIV therapy very early one.
My research focuses on improving engagement with medical care among pregnant and postpartum HIV-infected women in the South, which is significantly impacted by the HIV epidemic. I have been collaborating with clinicians, including Dr. Hannah Gay and Dr. Binford Nash at the University of Mississippi Medical Center, to better understand the barriers to care among these women. I think another key message in this case is that the child was out of care for five months, at which time she did not receive any of the medical treatment she may have needed. Her mother did not receive any prenatal, and given the story, probably did not obtain medical care after her delivery either. These are very salient issues that continue to drive the HIV epidemic in this country.
Filed under: Miriam,