New hope: Another baby made HIV-free

A researcher says there might be even more cases in Canada and South Africa.

NEW YORK TIMES NEWS SERVICEMarch 6, 2014 

BOSTON — When scientists made the stunning announcement last year that a baby born with the virus that causes AIDS had been cured through aggressive drug treatment just 30 hours after birth, there was skepticism that the child had not been infected in the first place.

But on Wednesday, the existence of a second such baby was revealed at an AIDS conference, leaving little doubt that the treatment works.

A clinical trial in which up to 60 babies who are born infected will be put on drugs within 48 hours is set to begin soon, and researchers are hoping for promising results.

If that trial works — and it will take several years of following the babies to determine whether it has — the protocol for treating all 250,000 babies born infected each year worldwide will no doubt be rewritten.

“This could lead to major changes, for two reasons,” said Dr. Anthony Fauci, executive director of the National Institute for Allergy and Infectious Diseases. “Both for the welfare of the child, and because it is a huge proof of concept that you can cure someone if you can treat them early enough.”

The announcement was the third piece of hopeful news in two days about HIV.

On Tuesday, scientists reported that injections of long-lasting AIDS drugs fended off infection in monkeys, and on Wednesday researchers announced a “gene editing” advance that might enable immune cells to repel the virus.

The first infant to make an apparent recovery from HIV infection, now famous as the “Mississippi baby,” was described last March at the Conference on Retroviruses and Opportunistic Infections, the same annual meeting where the new case was reported Wednesday.

The Mississippi child, now older than 3, is still virus-free, said Dr. Deborah Persaud, a virologist who has run ultrasensitive tests on both children in her lab at the Johns Hopkins Children’s Center in Baltimore.

The second baby, a girl born at Miller Children’s Hospital in Long Beach, Calif., is now 9 months old and free of the virus.

Her mother, suffering from both advanced AIDS and mental illness, arrived in labor; she had been prescribed drugs to protect her baby but had not taken them.

Four hours after the birth, a pediatrician, Dr. Audra Deveikis, drew blood for an HIV test and immediately started the baby on three drugs — AZT, 3TC and nevirapine — at the high doses usually used for treatment of the virus.

‘CRITICAL’ TREATMENT

The normal preventive regimen for newborns would be lower doses of two drugs; doctors usually do not use the more aggressive treatment until they are sure the baby is infected, and then sometimes not in the first weeks.

“Of course I had worries,” Deveikis said. “But the mother’s disease was not under control, and I had to weigh the risk of transmission against the toxicity of the meds.

“I’d heard of the Mississippi baby, I’d watched the video. I knew that if you want to prevent infection, early treatment is critical.”

The Long Beach baby is now in foster care, she said. The mother is still alive.

It is incorrect to describe the baby as “cured” or even as “in remission” because she is still on the drugs, Persaud said. But because the most sensitive blood tests can find no virus capable of replicating, she describes the baby as “having sero-reverted to HIV-negative.”

Both DNA and RNA of the virus were found in the baby’s early blood and spinal fluid samples, so Persaud said it was virtually certain she was infected at birth. The virus began to disappear six days after birth and was undetectable within 11 days.

It is considered medically unethical to stop the baby’s drugs now, but Deveikis and Dr. Yvonne Bryson, a pediatric AIDS expert at UCLA, said they would consider stopping them briefly to see what happens if the baby is still virus-free at age 2.

Bryson is one of three investigators who will lead the clinical trial seeking 60 babies.

Although antiretrovirals prevent the virus from replicating, a small amount usually persists in reservoirs throughout the body, integrated into the DNA of cells. Persaud’s test can activate those cells and force them to “spit out” the virus, where it can be detected.

Dr. Steven Deeks, an AIDS expert at the University of California, San Francisco, said the Long Beach baby offers more convincing evidence that starting therapy virtually at birth seems to kill the virus before it establishes a permanent reservoir.

“But it sure would be nice to have a way to decide when to stop” the treatment, he said. “That’s the next question.”

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