Dr. Hannah Gay and her medical team may have made medical history by effectively curing a child born with HIV.
The child, who is now two and a half, needs no medication for HIV, has a normal life expectancy and is highly unlikely to infect other people, it was announced on Sunday at the Conference on Retroviruses and Opportunistic Infections in Atlanta.
According to The Guardian, medical staff and scientists are unclear as to why the treatment was effective, but the success has raised hopes.
Doctors did not release the name or sex of the child to protect the patient’s identity, but said the infant was born in Mississippi.
Dr. Gay, who led the care for the child at the University of Mississippi Medical Center, told The Guardian that this was 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."
Usually women with HIV are given antiretroviral drugs during pregnancy. Their newborns take the drugs too, to reduce their risk of infection. This health care strategy can stop about 98% of HIV transmission from mother to child.
However, in this case, the mother was unaware she had HIV until after a standard test came back positive while she was in labor.
“She was too near delivery to give even the dose of medicine that we routinely use in labor. So the baby’s risk of infection was significantly higher than we usually see,” said Dr. Gay.
Doctors began treating the baby 30 hours after birth. Usually, they give the child a single antiretroviral drug, but this time they gave the infant three antiretroviral drugs. The doctors did this aggressive treatment because the mother had not received any during her pregnancy.
Several days later, blood taken 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 lab tests failed to detect it.
The child had no medication from the age of 18 months onward, 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,” Dr. 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, Dr. Gay ordered several HIV tests and was stunned by the results: “All of the tests came back negative, very much to my surprise."
Katherine Luzuriaga, an immunologist at Massachusetts Medical School, and Deborah Persaud at Johns Hopkins Children’s Center in Baltimore, did far more extensive blood tests on the child. They found traces of HIV, but no viruses that were capable of multiplying.
The medical team believe the child was cured because the treatment was so strong and given swiftly after birth. The drugs stopped the virus from replicating in short-lived, active immune cells.
The drugs also blocked the infection of white blood cells, called CD4, which can harbor HIV for years. These CD4 cells are 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.
Source: The Guardian