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article imageUS doctors say baby born with HIV was apparently cured

By JohnThomas Didymus     Mar 3, 2013 in Health
Doctors announced Sunday that a baby has been cured of HIV infection for the first time. If the claim is confirmed it could lead to a new approach to how newborns with HIV infection are treated and reduce the number of children living with the virus.
BBC reports that Dr Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, presented the findings at the Conference on Retroviruses and Opportunistic Infections in Atlanta. She reportedly said: "This is a proof of concept that HIV can be potentially curable in infants."
According to The New York Times, the baby was born in rural Mississippi. Doctors began treating her aggressively with anti-retroviral drugs about 30 hours after she was born.
Doctors say that if the treatment works for other babies it will change the way newborn babies with HIV infection are treated worldwide. The United Nations says about 330,000 babes were newly infected with the virus in 2011 and the most recent data suggests that more than 3 million children live with HIV globally.
This is not the first time that a cure for the HIV virus has been claimed. The first well-documented case of a cure involved the patient Timothy Brown known as the "Berlin patient." He was a middle-aged man with leukemia who received bone-marrow transplant from a donor genetically resistant to HIV infection.
Some experts are saying there will be need to firmly establish that the baby was truly infected and to show that it was not a case of prevention rather than cure. Prevention of HIV infection has been accomplished in baby's born to infected mothers through early aggressive therapy.
The New York Times reports that Dr. Daniel R. Kuritzkes, chief of infectious diseases at Brigham, said: "The one uncertainty is really definitive evidence that the child was indeed infected."
But Dr. Persaud and her colleagues say they are certain the bay was infected. According to the team, five tests yielded positive results in the baby's first month of life. Four of the tests were for viral RNA and one for DNA, The New York Times reports. According to the doctors, once the treatment started the virus levels in the baby's blood declined.
Persaud said they have little doubt that the child, who is now two-and-a-half years old, experienced a "functional cure." The doctors said the child has been off the drugs for a year and shows no signs of functional virus.
According to the CNN, a "functional cure" is when the presence of the virus is so small, that lifelong treatment is not necessary and standard clinical tests are unable to detect the virus in the blood.
The baby's mother arrived at a rural hospital in the fall of 2010. She gave birth to the baby prematurely. She did not know that she had HIV because she had taken no tests during her pregnancy. When tests showed she might be infected, her baby was transferred to the University of Mississippi Medical Center where treatment began when she was only about 30 hours old.
Hospital officials said an associate professor of pediatrics, Dr. Ben Gay, ordered tests and found that the child was infected. Doctors believed that the infection occurred in the womb rather than during delivery.
Normally, a newborn with an infected mother is treated with one or two drugs as prophylactic measure, but Gay said she began using a three-drug regimen to treat the infection. She said she began the treatment even before tests results confirmed the baby was infected.
CNN reports Gay said: "We started therapy as early as possible, which in this case was about 30 hours of age. And because it was a high-risk exposure, I decided to use three drugs rather than one."
Gay said virus levels in the child declined rapidly after treatment commenced and became undetectable by the time the baby was a month old. The situation remained the same until the baby was 18 months old.
According to Gay, when the baby and the mother returned five months later, tests remained negative.
Doctors at first suspected a laboratory error because they had expected to see a high viral load. They ordered more tests. Gay said: "To my greater surprise, all of these came back negative."
Gay then contacted experts at the University of Massachusetts, who conducted further tests and found only very small amounts of viral genetic material but no virus able to replicate
There have been unconfirmed claims in the past about babies clearing virus load without treatment but because tests were not so sensitive, they could not be confirmed. But this recent case suggests to some experts that babies' immune systems may have unique powers to clear virus load.
AP reports Dr. Anthony Fauci of the National Institutes of Health, said: "You could call this about as close to a cure, if not a cure, that we've seen."
According to Fauci, "That goes along with the concept that, if you treat before the virus has had an opportunity to establish a large reservoir and before it can destroy the immune system, there’s a chance you can withdraw therapy and have no virus."
But Dr. Steven Deeks, professor of medicine at the University of California San Francisco, argued that if a reservoir was never established then the case could not be called a true cure. He wondered: "Was there enough time for a latent reservoir, the true barrier to cure, to establish itself?"
Experts say the case may prove especially relevant to developing countries where women often do not receive treatment to prevent their babies becoming infected during pregnancy.
According to AP, in developing countries only about 60 percent of infected pregnant women get treatment that prevents them passing the virus to their babies. The case is different in developed countries where transmission from mother to child is rare because infected mothers generally receive treatment during pregnancy.
Studies are being planned to to confirm the cure and show that it can be repeated with success in new cases. According to AP, Persaud's team is planning a study to try to prove that aggressive treatment of high-risk babies can cure HIV infection. She said: "Maybe we'll be able to block this reservoir seeding."
CNN reports Gay said: "We are hoping that future studies will show that very early institution of effective therapy will result in this same outcome consistently."
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