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June 01, 2013

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Baby reported cured of HIV

March 4, 2013
Courtesy of University of Massachusetts Medical School
and World Science staff

Sci­en­tists have re­ported the first “func­tional cure” of an HIV-infected in­fant, a find­ing they say could help pave the way to elim­i­nat­ing the in­fec­tion in chil­dren.

The in­fec­tion went in­to re­mis­sion af­ter doc­tors gave an­ti­retro­vi­ral ther­a­py with­in 30 hours of birth, the re­search­ers said, pre­sent­ing the find­ings March 3 at the an­nu­al Con­fer­ence on Retro­vi­ruses and Op­por­tunis­tic In­fec­tions in At­lan­ta. 

The prompt treat­ment, they added, likely led to the cure by stop­ping the forma­t­ion of hard-to-treat vi­ral “reser­voirs”—dor­mant cells re­spon­si­ble for re­ig­nit­ing the in­fec­tion in most HIV pa­tients with­in weeks of stop­ping ther­a­py.

“Prompt an­ti­vi­ral ther­a­py in new­borns that be­gins with­in days of ex­po­sure may help in­fants clear the vi­rus and achieve long-term re­mis­sion with­out life­long treat­ment by pre­vent­ing such vi­ral hide­outs from form­ing in the first place,” said the re­port’s lead au­thor, vi­rol­o­gist Deb­o­rah Per­saud of the Chil­dren’s Cen­ter at Johns Hop­kins Uni­vers­ity in Bal­ti­more.

“Our next step is to find out if this is a highly un­usu­al re­sponse... or some­thing we can ac­tu­ally rep­li­cate in oth­er high-risk new­borns.”

Per­saud and Uni­vers­ity of Mas­sa­chu­setts Med­i­cal School im­mu­nol­o­gist Kath­er­ine Luzu­riaga head­ed the re­search team. Pe­di­at­ric HIV spe­cial­ist Han­nah Gay of the Uni­vers­ity of Mis­sis­sip­pi Med­i­cal Cen­ter ac­tu­ally treated the ba­by, who is deemed “func­tionally cured.” This means a pa­tient has achieved long-term vi­ral re­mis­sion with­out life­long treat­ment, and stand­ard clin­i­cal tests fail to de­tect HIV replica­t­ion in the blood, though the vi­rus is still de­tectable by ul­tra­sen­si­tive meth­ods.

The child was born to an HIV-infected moth­er and re­ceived com­bina­t­ion an­ti­retro­vi­ral treat­ment be­gin­ning 30 hours af­ter birth, the sci­en­tists ex­plained. Tests showed pro­gres­sively di­min­ish­ing vi­ral pres­ence in the blood, un­til it reached un­de­tectable lev­els 29 days af­ter birth.

The in­fant re­mained on an­ti­vi­rals un­til 18 months, then stopped treat­ment and was not fol­lowed up for a while, the re­search­ers say. Ten months lat­er, the child un­der­went re­peat­ed stand­ard blood tests, none of which de­tected HIV. Test for HIV-specific an­ti­bod­ies—the stand­ard clin­i­cal in­di­ca­tor of HIV in­fec­tion—also stayed neg­a­tive.

Cur­rent­ly, high-risk new­borns—those born to moth­ers with poorly con­trolled in­fec­tions or whose moth­ers’ HIV sta­tus is dis­cov­ered around the time of deliver­y—receive a com­bina­t­ion of an­ti­vi­rals at proph­y­lac­tic, or pre­ven­ta­tive, doses for six weeks to head off in­fec­tion. They start ther­a­peu­tic doses if and once in­fec­tion is found. But this case, the in­ves­ti­ga­tors say, may change the cur­rent prac­tice by high­light­ing the cur­a­tive po­ten­tial of very early an­ti­retro­vi­ral ther­a­py.

The in­ves­ti­ga­tors cau­tion they don’t have enough da­ta to rec­om­mend change right now, but say the case pro­vides the ra­t­ionale to start “proof-of-principle” stud­ies in all high-risk new­borns.

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Scientists have reported the first “functional cure” of an HIV-infected infant, a finding they say could help pave the way to eliminating the infection in children. The infant’s infection went into remission after doctors gave antiretroviral therapy within 30 hours of birth, the researchers said, presenting the findings March 3 at the annual Conference on Retroviruses and Opportunistic Infections in Atlanta. The prompt treatment, they added, likely led to the cure by stopping the formation of hard-to-treat viral “reservoirs”—dormant cells responsible for reigniting the infection in most HIV patients within weeks of stopping therapy. “Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place,” said the report’s lead author, virologist Deborah Persaud of the Children’s Center at Johns Hopkins University in Baltimore. “Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns.” Persaud and University of Massachusetts Medical School immunologist and Katherine Luzuriaga headed the research team. Pediatric HIV specialist Hannah Gay of the University of Mississippi Medical Center actually treated the baby, who is deemed “functionally cured.” This means a patient has achieved long-term viral remission without lifelong treatment, and standard clinical tests fail to detect HIV replication in the blood, though the virus is still detectable by ultrasensitive methods. The child was born to an HIV-infected mother and received combination antiretroviral treatment beginning 30 hours after birth, the scientists explained. Tests showed progressively diminishing viral presence in the blood, until it reached undetectable levels 29 days after birth. The infant remained on antivirals until 18 months, then stopped treatment and was not followed up, the researchers say. Ten months later, the child underwent repeated standard blood tests, none of which detected HIV. Test for HIV-specific antibodies—the standard clinical indicator of HIV infection—also stayed negative. Currently, high-risk newborns—those born to mothers with poorly controlled infections or whose mothers’ HIV status is discovered around the time of delivery—receive a combination of antivirals at prophylactic, or preventative, doses for six weeks to head off infection. They start therapeutic doses if and once infection is found. But this case, the investigators say, may change the current practice by highlighting the curative potential of very early antiretroviral therapy. The investigators caution they don’t have enough data to recommend change right now, but say the case provides the rationale to start “proof-of-principle” studies in all high-risk newborns.