The case of a Mississippi child “cured” of HIV is a highlight of the 2013 Conference on Retroviruses and Opportunistic Infections.
The situation is unique because the baby received three high-dose antiretroviral medications starting at 31 hours old, and then fell out of care after several months. At 24 and 26 months, tests showed no detectable HIV in the bloodstream, though it was still present in some cells found in the blood.
Whether the child remains asymptomatic, with no detectable HIV in his blood over the long term, remains to be seen. But in 2009, my colleagues and I published a similar case study of a child who received three HIV medications early in life, then had an undetectable viral load and negative antibody tests for HIV. That patient is now 15 and healthy.
In our case, the patient did not fall out of care and continued on HIV medications despite the undetectable viral load. But like this newer case, my colleagues and I still detected HIV in some cells in the blood.
What does all this mean? In the US, babies born to HIV-positive mothers are much less likely to get infected with the virus. For example, in New York State in 1990, 25 to 40 percent of HIV-infected mothers transmitted HIV to their children, but in 2010, the transmission rate dropped to less than one percent. This dramatic decrease in mother-to-baby HIV transmission is largely due to laws that mandate:
• HIV counseling and testing for all women getting prenatal care in regulated facilities. (1996)
• Routine HIV screening for all infants. (part of the New York State Department of Health’s Newborn Screening Program, 1997)
• Expedited testing for mothers with an undetermined HIV status when they are ready to deliver. (1999)
While such laws helped dramatically decrease mother-to-baby HIV transmission, the incidence of this transmission route is still high in many nations, especially undeveloped countries.
The World Health Organization’s standard of care is to give any baby of an HIV-positive mother one medication to fight the virus (two medications if there is a higher risk of transmission) for the first 28 days. This new study highlights the potential benefits of administering three medications to newborns with HIV-positive mothers. Still, researchers and physicians must weigh the encouraging results of this single case against the potential risks of giving these medications early in life.
This study also helps us understand the role of HIV that “hides out” in the human host in viral reservoirs and provides useful information for future studies, which may then lead to eliminating HIV from patients.
Most importantly, this is only one very interesting case. Continuous monitoring of this child’s health will determine if the HIV that remains in some of his cells becomes active again.
Annals of Allergy, Asthma & Immunology 2009