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Doctors claim to have cured girl of HIV (baby/CROI)
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News
BMJ 2013 March 5
Bob Roehr
Doctors claim to have cured a child of HIV through the very early administration of antiretrovirals.
The initial treatment was carried out at the University of Mississippi, and the follow-up search to detect the virus was done at Johns Hopkins University, Baltimore. The case was presented at the 20th annual Conference on Retroviruses and Opportunistic Infections in Atlanta this week.
The girl was born somewhat prematurely to a mother who did not know that she was infected with the virus and who had a high viral load. The girl was born with HIV. The virus can be transmitted from mother to child in utero or at delivery, and the likelihood of transmission increases with the viral load.
A blood test of the newborn baby found a viral load of 20 000 copies, and she was started on antiretrovirals within 30 hours of birth. The kinetics of viral infection and replication make it likely that she had become infected in utero and not at birth. The drugs were continued for about 18 months before the mother and child fell out of the healthcare system.
At 22 months the girl returned to healthcare and was tested for HIV after a period of not taking antiretrovirals. A test that could detect as few as 20 copies of the virus could not find it. Deborah Persaud and colleagues at Johns Hopkins then used ultrasensitive research assays but "were unable to detect replication competent virus." The girl, now two and a half years old, remains off treatment, and the virus continues to be undetectable.
"We believe that perhaps the initiation of very early antiretroviral therapy prevented the formation of viral reservoirs in CD4 T cells," said Persaud.
Scott Hammer, a researcher at Columbia University and vice chairman of the conference, told the BMJ that the findings were "intriguing." But he was not alone in raising questions about the research and interpreting its findings. Among them were verifying the initial viral load and whether the virus detected was capable of infection, which is not always the case.
"The question is whether the HIV DNA [detected by the study] is junk DNA or replication competent DNA," said Hammer. "Or is this an example of an elite controller, and the baby would have cleared the virus without drugs?"
So called elite controllers, less than 1% of those who become infected, have an immune system that is capable of controlling the infection for long periods of time, up to several decades, at very low levels and without clinical symptoms of disease.
A comparison could be drawn with the so called "Berlin patient," Timothy Ray Brown, the only person acknowledged to have been cured of AIDS. Brown, who had tested HIV positive, underwent chemotherapy for lymphoma and a bone marrow transplantation to rebuild his immune system. The doctor secured a transplant match that contained a rare variation, the σ-32 mutation for the CCR5 cell receptor, known to naturally confer resistance to HIV infection.
Many experts were initially skeptical of the claim for a cure in that instance, and several years of additional data were needed before the claim became widely accepted.
Kevin Robert Frost, chief executive of amfAR (American Foundation for AIDS Research), which funded some of the study of this child, told the BMJ that its impact in the United States would be minimal, because fewer than 50 infants a year were born with HIV, thanks to prenatal care that can prevent transmission from mothers to their babies. It has greater potential value in developing countries. However, many of these countries have not fully implemented existing programs to greatly reduce perinatal transmission of HIV.
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