HIV specialists take stock after virus reappears in ‘cured’ girl
The Guardian | July 11, 2014
The brave hopes of HIV scientists that they were on the path towards a cure for Aids have received a considerable blow with the news from the US that, after appearing to have been totally cleared from the body of one small girl, the virus has been detected again.
The Mississippi baby was the poster child of the "hunt for a cure", which is the mantra scientists and campaigners have adopted since more widely available drugs stemmed the rise in the Aids pandemic and reduced the sense of emergency. We have never known her name, but the child treated in the Jackson Memorial Hospital in Mississippi appeared to be living proof that it was possible to outwit the virus. Studies have been planned to test the treatment she received in other babies. Now there will have to be a rethink. Throughout the HIV community, there will be real dismay.
Pregnant women with HIV are put on antiretroviral drugs to suppress the virus in their blood, for their own health and to protect their baby. In North America and Europe, the vast majority of babies with HIV-positive mothers are born free of the virus as a result. The Mississippi baby's mother, however, had never attended an antenatal clinic. Dr Hannah Gay, a paediatric HIV consultant at the hospital, took the decision to put the baby on a particularly strong course of antiretroviral drugs within 30 hours of the birth, before she even had any HIV test results. This was an unusual procedure, but sure enough, when the test results came back, they confirmed HIV in the baby.
The child continued to be given antiretroviral drugs for 18 months, when doctors lost contact with her. Ten months later, mother and daughter reappeared. When tests were done, there was no sign of the virus anywhere in the girl's body. A buzz of amazement and excitement went around the world. But now, at nearly four years old, the regular tests to which the child has been subjected have shown traces of the virus once again. She is no longer in remission and has been put back on treatment.
HIV has proved a formidable opponent for scientists trying to develop vaccines as well as drugs because of its ability to hide in the body. Drugs can suppress the virus until it is almost undetectable, but once they are stopped, the virus rebounds.
The events in Mississippi may still teach scientists a great deal. It does appear that treatment hit the virus harder in this child's case than anyone has managed to do before. Other doctors have been keen to try the approach. In March it was revealed that a second baby, in Los Angeles, had been treated with a similar strong cocktail of drugs within just four hours of her birth. Tests could not find the virus afterwards, but that baby is still on treatment and now likely to remain so.
There have been plans in the US to carry out a federally funded study of early aggressive treatment in newborn babies with HIV. If there was no sign of HIV after two years, doctors would stop the drugs. Whether such a study can now be ethically done will be in question.
"We're going to take a good hard look at the study and see if it needs any modifications," said Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. At a minimum, consent forms to join the study would have to be revised, he said. He added that scientists remained committed to finding a cure for HIV.
Jeffrey Safrit, research chief at the Elizabeth Glaser Pediatric AIDS Foundation, was one of those to offer an upbeat view. "What we've learned from this case is really quite amazing," he said. "They were able to suppress the virus for a very long time without therapy. We need to take the positive aspects of this case and learn from them to move forward [with the federal study]".
Hopes have been raised before. Like the Mississippi baby, the "Berlin patient" appeared to offer a blueprint for a cure when his story emerged in 2008. The patient was an American, Timothy Ray Brown, who received a bone marrow stem cell transplant in Germany to treat his cancer, acute myeloid leukaemia. His doctors managed to get the donation from a man who is one of the small minority who have natural immunity to HIV. Brown's HIV has not recurred. Stem cell transplants from donors have since been given to other people with HIV, but the virus has always made a comeback.
At the International Aids Conference, which opens in Melbourne at the end of next week, the promise of babies freed from HIV was expected to be one of the biggest and most hopeful themes. Now there will be a lot of stoical talk from HIV specialists about what can be learned from the setback. They have been here before and will be here again before HIV is, hopefully, finally conquered.