“It Was the Turning Point of My Career” - Scientist Talks about the Mississippi HIV Cure
By Jane Coaston | March 7, 2013
This week, the world was stunned by news of a baby in Mississippi who was functionally cured of HIV. The lead author of the case study was Dr. Deborah Persaud, a pediatric infectious disease specialist at the Johns Hopkins University and a 2005 recipient of the Elizabeth Glaser Scientist Award (EGSA). Her research has focused on using sophisticated analysis to find traces of HIV in the cells of infants and children to learn more about the virus and how it can be eliminated in children. Chair of a clinical trial group called IMPAACT (International Maternal Pediatric Adolescent AIDS Clinical Trials), Dr. Persaud is focused on creating HIV treatment trials for children to learn if they can be cured of HIV through very early treatment.
The baby in Mississippi was born HIV-positive – the child’s mother was unaware of her own positive status, and was tested too late to begin the standard prevention of mother-to-child transmission (PMTCT) treatment protocol used for pregnant women. “We know that infants infected in utero will have a positive HIV nucleic acid test, “Dr. Persaud said in an interview with EGPAF. “The virus has had time to establish a foothold.”
Dr. Persaud learned of the case in Mississippi from another EGSA winner, Dr. Katherine Luzuriaga of the University of Massachusetts. An immunologist, Dr. Luzuriaga was contacted by Dr. Hannah Gay, who first identified the child and organized the three-drug course of treatment. Dr. Gay sought out Dr. Luzuriaga after testing the child for HIV following several months without treatment and finding no signs of the HIV virus using standard testing. “(The child’s) tests should have been positive, “Dr. Persaud said. “(But) kids who are treated early (less than 3 months of age) – if they maintain good control on the 3-drug regimen, nearly 80 percent stay antibody negative, so the standard antibody test can’t be used. The question was ‘is HIV still present?’” HIV may be undetectable by standard methods, but can have inserted itself into cellular DNA and be unreachable by the immune system or any available medications.
Dr. Persaud has pioneered the use of special tests that can find HIV, so Dr. Luzuriaga contacted her to check the child’s blood samples for any signs of the virus. Her results were shocking: after two separate tests for HIV at 24 and 26 months of age, and after the child had been off treatment for nearly a year, she said, “we were unable to detect any evidence that HIV was present in a replicable form. “ In addition, the child’s CD4 counts (a standard method of indicating the progression of HIV) were totally normal 12 months after receiving treatment. “This is the first well-documented case of a cure,” Dr. Persaud said. She added that the next step is to replicate this study. “We already have in development a clinical trial to find out if an infected child can end up with a cure (using this method). We did not anticipate the media attention – we really have to move very quickly to move this into the field. This has huge implications for treatment of HIV-infected infants globally.” She said that in many areas where pediatric HIV is particularly burdensome, the three drugs used in this case are available. “If this can be replicated, this can be scaled up very quickly.”
Dr. Persaud describes the child as being “functionally” cured of HIV. “This reflects that this is a child infected with HIV (who) went off antiretroviral treatment and was able to control the virus, which is undetectable via standard testing.” The child still has some signs of HIV in its DNA and RNA, but the viral load is extremely low and the HIV appears to be unable to reproduce itself. Dr. Persaud said that this means that once the child grows up and becomes sexually active, “The likelihood of transmission through sex would be highly, highly unusual.”
Dr. Persaud paid special tribute to the role of the Elizabeth Glaser Pediatric AIDS Foundation. “(The Elizabeth Glaser Scientist Award) was the turning point of my career.” Through the Elizabeth Glaser Scientist Award, Dr. Persaud was able to conduct the first studies on how HIV can hide in the body, avoiding standard means of detection. “The Award really distinguishes your work and helps you collaborate with experts in the field.“ Dr. Persaud says that the impact of EGPAF on her career has been “phenomenal” and added that the case in Mississippi is part of Elizabeth Glaser’s vision for children living with HIV. “I feel this case culminates what Elizabeth Glaser really wanted for children with pediatric HIV – including her own kids. “
Jane Coaston is Media Relations Coordinator for the Foundation, based in Washington, D.C.