New details about the 3-year-old girl born with and possibly “cured” of HIV, and published in the New England Journal of Medicine, may offer hope to others who are fighting to eradicate the virus, primarily infants. Doctors reviewing the unique case have confirmed that the toddler was infected with HIV and her viral count was reduced to an undetectable level by very early drug therapy. The new results might open the door for a large-scale experiment to take place, in order to test the effects of early drug therapy on infants who have a high risk of HIV infection, shortly after birth.
The girl was born in Mississippi to a mother infected with HIV-1. 30 hours after her birth she began receiving antiretroviral therapy (ART) – faster than most infants born with HIV are treated – and continued therapy as a combination of three drugs: zidovudine, nevirapine, and lamivudine. Somewhere between 15 and 18 months after the child’s birth, however, the mother discontinued her daughter’s drug therapy due to her own life circumstances.
Yet at the 23-month mark, when the child was tested again, her doctors were surprised to find that the virus was undetectable in her system, suggesting that very early ART in babies could force the viral numbers to such a low that they may hardly be detectable. After the child was tested at five different labs, the viruses were still unable to be traced. In March 2013, the media picked up the story after doctors presented her case at a meeting in Atlanta. The girl became the second person to be considered “cured” – or as close to cured as possible thus far – of HIV, the other being the “Berlin Patient,” whose levels of HIV were undetectable after he received a bone marrow transplant.
Until the report was released today, doctors working on the child’s case had been wary to call the patient “cured,” and had tested her blood to consider every possibility for its undetectable levels of HIV, Dr. Katherine Luzuriaga of the University of Massachusetts in Worcester told NPR. “There was some very healthy skepticism,” she said. Some of that skepticism included doctors who believed the child was not actually infected with HIV, but rather simply carrying some free-floating viruses from her mother at the time of her birth; however, the new results prove that the child was indeed infected.
“At the time of this report, the child had not received any antiretroviral drugs through 30 months of age, and the plasma level of HIV-1 RNA had remained undetectable by routine clinical assays,” the authors of the article write in the case report. But scientists and doctors continue to hesitate to use the word “cured,” as the undetectable virus levels in the girl most likely means the HIV is still present in viral nucleic acids – not eradicated completely – just driven to a low, harmless amount because of the early drug treatment. This is why doctors are referring to it as “remission,” not cure.
"The question is whether those viral nucleic acids have the ability at some point to replicate and allow a rebound of the virus," Luzuriaga told NPR. "That's why it's important to continue to test the baby over time."
The international experiment that will test early drug therapy in newborn infants will begin in January, to see if the case can be replicated. The goal is to find a way to spare infants a lifetime of antiretroviral therapy by pumping them with aggressive drugs within the first few weeks and months of their birth.