US Doctor cures baby with HIV

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The Guardian

US doctors cure child born with HIV

Mississippi doctors make medical history made with first 'functional cure' of unnamed two-year-old born with the virus who now needs no medication

• Research provides hope of a 'functional cure' for AIDS

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Ian Sample, science correspondent
The Guardian, Sunday 3 March 2013
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Link to video: HIV baby cured by US doctors

Doctors in the US have made medical history by effectively curing a child born with HIV, the first time such a case has been documented.

The infant, who is now two and a half, needs no medication for HIV, has a normal life expectancy and is highly unlikely to be infectious to others, doctors believe.

Though medical staff and scientists are unclear why the treatment was effective, the surprise success has raised hopes that the therapy might ultimately help doctors eradicate the virus among newborns.

Doctors did not release the name or sex of the child to protect the patient's identity, but said the infant was born, and lived, in Mississippi state. Details of the case were unveiled on Sunday at the Conference on Retroviruses and Opportunistic Infections in Atlanta.

Dr Hannah Gay, who cared for the child at the University of Mississippi medical centre, told the Guardian the case amounted to the first "functional cure" of an HIV-infected child. A patient is functionally cured of HIV when standard tests are negative for the virus, but it is likely that a tiny amount remains in their body.

"Now, after at least one year of taking no medicine, this child's blood remains free of virus even on the most sensitive tests available," Gay said.

"We expect that this baby has great chances for a long, healthy life. We are certainly hoping that this approach could lead to the same outcome in many other high-risk babies," she added.

The number of babies born with HIV in developed countries has fallen dramatically with the advent of better drugs and prevention strategies. Typically, women with HIV are given antiretroviral drugs during pregnancy to minimise the amount of virus in their blood. Their newborns go on courses of drugs too, to reduce their risk of infection further. The strategy can stop around 98% of HIV transmission from mother to child.

In the UK and Ireland, around 1,200 children are living with HIV they picked up in the womb, during birth, or while being breastfed. If an infected mother's placenta is healthy, the virus tends not to cross into the child earlier in pregnancy, but can in labour and delivery.

The problem is far more serious in developing countries. In sub-Saharan Africa, around 387,500 children aged 14 and under were receiving antiretroviral therapy in 2010. Many were born with the infection. Nearly 2 million more children of the same age in the region are in need of the drugs.

In the latest case, the mother was unaware she had HIV until after a standard test came back positive while she was in labour. "She was too near delivery to give even the dose of medicine that we routinely use in labour. So the baby's risk of infection was significantly higher than we usually see," said Gay.

Doctors began treating the baby 30 hours after birth. Unusually, they put the child on a course of three antiretroviral drugs, given as liquids through a syringe. The traditional treatment to try to prevent transmission after birth is a course of a single antiretroviral drug. The doctor opted for the more aggressive treatment because the mother had not received any during her pregnancy.

Several days later, blood drawn from the baby before treatment started showed the child was infected, probably shortly before birth. The doctors continued with the drugs and expected the child to take them for life.

However, within a month of starting therapy, the level of HIV in the baby's blood had fallen so low that routine lab tests failed to detect it.

The mother and baby continued regular clinic visits to the clinic for the next year, but then began to miss appointments, and eventually stopped attending all together. The child had no medication from the age of 18 months, and did not see doctors again until it was nearly two years old.

"We did not see this child at all for a period of about five months," Gay told the Guardian. "When they did return to care aged 23 months, I fully expected that the baby would have a high viral load."

When the mother and child arrived back at the clinic, Gay ordered several HIV tests, and expected the virus to have returned to high levels. But she was stunned by the results. "All of the tests came back negative, very much to my surprise," she said.

The case was so extraordinary, Dr Gay called a colleague, Katherine Luzuriaga, an immunologist at Massachusetts Medical School, who with another scientist, Deborah Persaud at Johns Hopkins Children's Centre in Baltimore, had far more sensitive blood tests to hand. They checked the baby's blood and found traces of HIV, but no viruses that were capable of multiplying.

The team believe the child was cured because the treatment was so potent and given swiftly after birth. The drugs stopped the virus from replicating in short-lived, active immune cells, but another effect was crucial. The drugs also blocked the infection of other, long-lived white blood cells, called CD4, which can harbour HIV for years. These CD4 cells behave like hideouts, and can replace HIV that is lost when active immune cells die.

The treatment would not work in older children or adults because the virus will have already infected their CD4 cells.

"Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place," said Dr Persaud. "Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns."

Children infected with HIV are given antiretroviral drugs with the intent to treat them for life, and Gay warned that anyone who takes the drugs must remain on them.

"It is far too early for anyone to try stopping effective therapy just to see if the virus comes back," she said.

Until scientists better understand how they cured the child, Gay emphasised that prevention is the most reliable way to stop babies contracting the virus from infected mothers. "Prevention really is the best cure, and we already have proven strategies that can prevent 98% of newborn infections by identifying and treating HIV-positive women," she said.

Genevieve Edwards, a spokesperson for the Terrence Higgins Trust HIV/Aids charity, said: "This is an interesting case, but I don't think it has implications for the antenatal screening programme in the UK, because it already takes steps to ensure that 98% to 99% of babies born to HIV-positive mothers are born without HIV."

Thoughts?

[ArmorPierce]

I don't get what's the big deal. Its been known that giving antiviral medication right after exposure before the virus has gained a foothold will effectively prevent HIV from taking hold and indeed it is mentioned in this article. It seems like they just straddled the period between prior to virus gaining a strong enough foothold and it being too late.

[Dalton]

I think this is the first time it's been described as a "functional cure". In any case it's a step in the right direction. Fuck Yeah Science.

[Sea Skimmer]

I don't get what's the big deal. Its been known that giving antiviral medication right after exposure before the virus has gained a foothold will effectively prevent HIV from taking hold and indeed it is mentioned in this article. It seems like they just straddled the period between prior to virus gaining a strong enough foothold and it being too late.

We can use drugs to stop the virus from ever taking hold in a baby yes, but in this case the baby did test positive, and was then apparently cured. That has only happened once before in a fluke case nobody could ever explain, involving the persons own immune system rather then drug treatment.

[Ziggy Stardust]

That has only happened once before in a fluke case nobody could ever explain, involving the persons own immune system rather then drug treatment.

IIRC, he got a blood transfusion from someone who has a natural resistance to the virus, which is extremely rare.

[Losonti Tokash]

It was a bone marrow transplant as a treatment for leukemia, but yeah.

[Formless]

Closely related:

Early HIV drugs 'functionally cure about one in 10'
By James Gallagher Health and science reporter, BBC News

[snip image] HIV HIV, in green, bursting out of a white blood cell it has hijacked

Rapid treatment after HIV infection may be enough to "functionally cure" about a 10th of those diagnosed early, say researchers in France.

They have been analysing 14 people who stopped therapy, but have since shown no signs of the virus resurging.

It follows reports of a baby girl being effectively cured after very early treatment in the US.

However, most people infected with HIV do not find out until the virus has fully infiltrated the body.

The group of patients, known as the Visconti cohort, all started treatment within 10 weeks of being infected. The patients were caught early as they turned up in hospital with other conditions and HIV was found in their blood.

They stuck to a course of antiretroviral drugs for three years, on average, but then stopped.

The drugs keep the virus only in check, they cannot eradicate it from its hiding places inside the immune system.

Normally, when the drugs stop, the virus bounces back.

Control

This has not happened in the Visconti patients. Some have been able to control HIV levels for a decade.

Dr Asier Saez-Cirion, from the Institute Pasteur in Paris, said: "Most individuals who follow the same treatment will not control the infection, but there are a few of them who will."

He said 5-15% of patients may be functionally cured, meaning they no longer needed drugs, by attacking the virus soon after infection.

"They still have HIV, it is not eradication of HIV, it is a kind of remission of the infection."

Their latest study, in the journal PLoS Pathogens, analysed what happened to the immune system of the patients.

Early treatment may limit the number of unassailable HIV hideouts that are formed. However, the researchers said it was "unclear" why only some patients were functionally cured.

Dr Andrew Freedman, a reader in infectious diseases at Cardiff University School of Medicine, said the findings were "certainly interesting".

"The presumption is that they've started treatment very early and the virus hasn't spread to so many of the long-term reservoirs and that's why it works.

"Whether they'll control it forever, or whether it'll be for a number of years and subsequently they will progress and the virus will reappear, we don't know."

However, he cautioned that many patients would be diagnosed much later than in this study.

Deborah Jack, the chief executive of the National AIDS Trust said it was "exciting times" in progress towards an HIV cure, but the key was early treatment.

"This just underlines the importance of people being testing and diagnosed early. Currently half of people living with HIV in the UK are diagnosed late - indicating that they are likely to have been infected for five years."

[ArmorPierce]

Update Necro to the story. Looks like the HIV infection has returned

http://news.discovery.com/human/health/ ... 140711.htm

Washington (AFP) - A girl who was born HIV-positive but was treated early and showed no signs of the disease for years has seen her infection return, US doctors said Thursday.

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The girl's story had raised hopes that doctors may have found a way to cure young children who are born HIV-positive, simply by giving them strong anti-retroviral drugs shortly after birth.

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"Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child's care and the HIV/AIDS research community," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Known widely as the "Mississippi baby," she was born to an HIV-positive mother in 2010 and was given a potent dose of anti-retroviral medication 30 hours after birth.

She continued taking the medications until the age of 18 months, when doctors lost track of her. When she returned five months later, doctors could find no sign of the virus, even though she had not been taking her daily pills.

The child continued to stay off treatment and showed no sign of the virus for more than two years.

"Typically, when treatment is stopped, HIV levels rebound within weeks, not years," said Deborah Persaud, professor of infectious diseases at the John Hopkins Children's Center in Baltimore.

Persaud described the child's response as "unprecedented."

Now age four, she was tested during a routine clinical care visit earlier this month, and was found to have detectable HIV levels in her blood.

She also had a decreased T-cell count and the presence of HIV antibodies, signaling that her body was fighting the infection and that HIV was actively replicating again in her body.

The girl, whose identity has not been released, is now being treated once again with anti-retroviral medication and is doing well, Fauci said.

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"The case of the Mississippi child indicates that early anti-retroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for anti-retroviral medication over a considerable period," said Fauci.

Researchers must now turn their attention to understanding why and how the child went into remission, with the hope of extending that time period even further in future cases, he said.

The Mississippi baby's case was detailed in the New England Journal of Medicine in 2013.

Earlier this year, researchers reported a second case of an infant, this time in California, who was treated within hours of birth and whose HIV remained undetectable nearly a year later.

However, that child was still taking anti-retroviral drugs, and doctors said they would not consider taking her off them until she reached the age of two.