Last March, a baby born with H.I.V. was reported to have been cured of the infection for the first time in history, a momentous step in the fight to cure AIDS. Yet federal officials announced Thursday that the child showed signs of infection during a routine blood test.
The baby, born in rural Mississippi, was treated with drug therapy over a year and a half. The baby's mother didn't know she had H.I.V. until she gave birth prematurely. Usually newborns with infected mothers are given one or two drugs, but doctors immediately put the baby on a form of anti-retro viral therapy called triple therapy. Often the virus requires an aggressive treatment from various angles and cannot be treated with just a single drug, instead requiring a three-drug regimen.
Given the success of the Mississippi case, doctors were making plans to have a clinical trial worldwide involving 450 babies infected with H.I.V. If the trial had occurred, babies would have been selected if their infected mothers had no existing testing or treatment before their babies’ birth. If the children showed no signs of the virus after 48 weeks of treatment, doctors would cease to administer drugs. Physicians would then see if the virus could establish itself within infected cells.
In 2011, 330,000 infants were infected at birth or immediately afterward, according to Avert.org. Within 30 hours of birth, doctors usually begin heavy antiretroviral treatment, sometimes lasting as long as three years.
Before the Mississippi child, the only other person who had been considered to be cured of H.I.V. was an adult named Timothy Brown. The previously anonymous “Berlin patient” had a blood stem cell transplant to treat the leukemia that had eradicated his bone marrow. The blood stem cells he received from a matching donor had a rare mutation that lacked the surface receptor the virus typically uses as a conduit to enter the body. “Because he had leukemia, he received two transplants from someone who had mutations. It made it difficult for the virus to get into their cells,” Dr. Audra Deveikis explained to Newsweek.
Dr. Deveikis, the Medical Director at Bickerstaff Family Center at Miller Children’s Hospital Long Beach, Calif., had been working with a second baby said to have been cured of H.I.V. Doctors in California didn’t clear the baby as cured, though, because the baby couldn’t be taken off antiretroviral drugs ethically (the baby was in foster care as her mother had advanced AIDS and was mentally ill). Yet taking the baby off of drugs and then waiting to see if the virus manifests itself again is currently the only test to date ensuring whether or not the virus has been eradicated.
The mother in the Mississippi case disappeared with the baby after 18 months of initial treatment. When the baby reappeared five months later, doctors found no traces of the virus in the baby’s blood or tissue. Typically the virus will reappear after a few weeks, but the Mississippi baby remained free of the virus for two years. “It’s sort of normal that the baby will be responding to therapy. After you take them off of treatment, not finding the virus – that’s unusual,” said Dr. Deveikis.
What makes H.I.V. so resistant to treatment is that it’s not just a blood disease. When the virus first enters the body, it invades CD4 white blood cells and makes millions of copies of itself. Then those copies spread into reservoirs of cells throughout the body, often into intestines and lymph nodes. The virus is often dormant in other areas of the body and then trickles back into the bloodstream.
A few weeks ago, the virus was detected once again with the Mississippi baby through a blood test. The child is again on triple therapy and is expected to continue treatment.
The news last year re-ignited the hope for an AIDS cure, which has remained elusive since the first documented case in 1981. Researchers are looking into alternative treatment and a different approach to the trial, which has yet to begin nationally as scheduled.
“I’ve been doing this since 1995, and I see the suffering that children go through when they are infected,” said Dr. Deveikis. “I have been to many children’s funerals -- if I can do something for them to not get them sick I’m going to do anything possible.”