Girl who was declared ‘functionally cured’ of HIV now has active virus
Los Angeles Times | July 10, 2014
A girl who was seemingly cured of HIV following aggressive drug therapy just hours after her birth was recently discovered to be infected with the virus that causes AIDS after all, doctors announced Thursday.
The so-called Mississippi baby, now nearly 4 years old, had raised hopes of a potential cure for babies infected with HIV when it was first described at an AIDS conference last year. The girl's case also provided the foundation for an upcoming clinical trial.
The discovery recently that the 46-month-old child had actually carried the virus at undetectable levels for almost two years before it rebounded suddenly came as a blow to health officials and HIV experts.
“It felt very much like a punch to the gut,” said Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson who had treated the girl.
“It was extremely disappointing, both from the scientific standpoint that we had been very hopeful that this would lead to bigger and better things, but mainly for the sake of the child who now is back on medicine and expected to stay on medicine for a very long time,” Gay told reporters during a news conference.
The case of the Mississippi baby had made international headlines. Born prematurely to a mother infected with HIV, the infant was given a cocktail of three antiretroviral drugs 30 hours after birth. The baby remained on antiretroviral drugs for 18 months, after which the baby’s mother stopped taking her to see doctors and stopped administering the drugs.
Five months after that, doctors reexamined the child and found that even though antiretroviral treatment had been discontinued, her blood showed no detectable levels of HIV and no HIV-specific antibodies. Details of her case were published in October in the New England Journal of Medicine.
The child remained free of drugs and of detectable HIV for two years. However, during a routine screening this month, doctors detected the virus in her blood, as well as a drop in her immune cells. After sequencing the virus, doctors determined it was identical to the one that had infected her mother — a finding that confirmed that the baby had HIV at birth.
“There was some doubt as to whether the baby was infected,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. “The baby clearly was infected.”
The case, the only one of its kind documented, has raised many questions about scientists’ understanding of the virus and its ability to evade detection.
“There can still be persistent virus that can linger in a quiescent state that can come back at any time,” said Dr. Deborah Persaud, a professor of infectious diseases at Johns Hopkins Children’s Center in Baltimore.
“But the duration that this child has been off treatment really needs to be remembered here — 27 months of retroviral treatment,” said Persaud, who also worked on the girl's case. “So there’s really still hope that a very early treatment strategy for perinatal infection can achieve longer remission in other perinatal infected infants.”
The girl was immediately given antiretroviral drugs after the virus was detected, dropping levels of the virus in her blood and increasing immune cell counts. “The child is having excellent response to the therapy that was started,” Gay said.
The development was announced just as clinicians were poised to enroll participants in a long-planned clinical trial involving babies with HIV. The study is intended to determine whether such babies can safely discontinue drug treatment if they show signs that the infection has gone into a state of remission.
Dr. Yvonne Bryson, a co-chair of that clinical trial and a pediatric infectious disease expert at the David Geffen School of Medicine and Mattel Children’s Hospital at UCLA, said the enrollment would be postponed so that experts could review it for potential ethical issues.
“I don’t think there are any issues,” she said. “In fact, I think this news really points to the need to do more critical research.”
The case had raised the possibility that children born to infected mothers could be treated aggressively with drugs shortly after birth and taken off antiretroviral medication indefinitely if the virus couldn’t be detected. In light of this new development in the Mississippi case, some have questioned whether it's now ethical to proceed with a planned clinical trial.
Fauci, who is also involved in the study, was asked whether he saw any ethical problems with proceeding now.
“I think what would be questionable is if people on their own, without a clinical study, decided they were going to all of a sudden empirically stop therapy just to see if things were OK with the baby,” Fauci said. “That’s a different story than doing it under a very carefully controlled and monitored clinical trial.”
The Elizabeth Glaser Pediatric AIDS Foundation released a statement Thursday urging scientists to continue their research.
“Efforts to take what we have learned from this case and apply it to future studies must stay high on the HIV research agenda,” said Dr. R.J. Simonds, a vice president of the Washington-based organization. “At the same time, increasing access to treatment for children who are currently living with HIV remains equally critical.”