A Mississippi toddler has been essentially cured of an HIV infection at Batson Children's Hospital in Jackson, MS.
It's the first case of its kind in the world, and HIV specialists are extremely encouraged by the potential it holds in curing newborns who are infected with the virus by HIV infected mothers. Specialists call it a functional cure, or in layman's terms, long-term remission, even though trace amounts of the virus remain in the toddler, who is now two and a half years old.
The infant, high risk for HIV, arrived at Batson Children's Hospital in the fall of 2010. Dr. Hannah Gay is the pediatric HIV specialist at the University of Mississippi Medical Center who implemented a somewhat modified protocol of treatment for the unidentified infant, when the baby arrived at the hospital at 30 hours old.
Therapy would have normally been implemented in an infant under these circumstances almost immediately after birth.
"This baby was considered high risk for several reasons. First of all we were unable to treat the mom during pregnancy. Secondly, the baby was born somewhat prematurely. The baby was born by vaginal delivery as opposed to C-section," Dr. Gay explained.
Typically in a high risk infant, Dr. Gay says the standard HIV drug AZT is given as a precaution even before doctors can make an HIV diagnosis. But having missed that very early window of intervention, Dr. Gay made the decision, a fairly routine one, to move forward with a more aggressive treatment.
"I started more than one drug. I drew tests just as they started those drugs and two different types of tests showed me within the next couple of days that the baby was already infected," Dr. Gay said.
In addition to AZT, two other drugs, Neviripine and Lamivudine, were added to the child's treatment. Dr. Gay said the baby should have been on an HIV cocktail of medications for the rest of her life, but contact was lost with the mother and the baby.
Dr. Gay called the Mississippi State Department of Health to assist in locating them and returning the child to the Specialty Clinic at Batson Children's Hospital.
"At that point, the mom admitted that she had not been giving the medicine for the past several months and I fully expected the baby's viral load to have gone back up. But when we drew the test, we got back still an undetectable viral level," Dr. Gay said.
"This is the first case where actual infection has been documented and then lost later," Dr. Gay added.
The aggressive therapy appears to have stopped a process called replication. HIV replication is the vital life cycle of the Human Immunodeficiency Virus.
With replication, HIV thrives aggressively. Without it, it is considered functionally cured.
"The child has not redeveloped what we call replication competent virus so her virus has not come back into the blood and started replicating again. Therefore, she doesn't need the therapy," Dr. Gay continued.
Dr. Gay said while this development is more than encouraging, prevention is still the best method for infants born to infected mothers. She said the key is treating the pregnant mother and having complete control of the viral load in her body at the end of pregnancy and at delivery.
"The risk to the baby drops from 25% to 30% to less than two percent," Dr. Gay said.
On average in the past decade, Dr. Gay says approximately 60 to 75 infants a year are born in Mississippi to HIV infected mothers. She says because of current protocols in place for treating the mother, most years Mississippi does not have any HIV transmission to the baby.
Because this is a very rare and unique case, Dr. Gay says they don't really know what to expect in the future for this child.
Researchers at Johns Hopkins and the University of Massachusetts Medical School have now taken information from the case in hopes of repeating the outcome, which could one day lead to a standard therapy to cure HIV in infants who are born with the disease.
The findings of the research have been presented at the 20th Conference on Retroviruses and Opportunistic Infections in Atlanta, GA.