Mississippi Baby Media Coverage
1. The Guardian
2. New Scientist
3. BBC News Health
4. AFP
5. Reuters
6. AP
7. The New York Times
8. The Washington Post
9. Los Angeles Times
10. Nature
11. Science News
12. Channel 4
13. NRP
14. Le Monde
15. France 24
16. RFI
17. Liberation
18. ABC
19. CNN
20. NBC
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The Guardian
US doctors cure child born with HIV
Mississippi doctors make medical history made with first 'functional cure' of unnamed two-year-old born with the virus who now needs no medication
Doctors in the US have made medical history by effectively curing a child born with HIV, the first time such a case has been documented.
The infant, who is now two and a half, needs no medication for HIV, has a normal life expectancy and is highly unlikely to be infectious to others, doctors believe.
Though medical staff and scientists are unclear why the treatment was effective, the surprise success has raised hopes that the therapy might ultimately help doctors eradicate the virus among newborns.
Doctors did not release the name or sex of the child to protect the patient's identity, but said the infant was born, and lived, in Mississippi state. Details of the case were unveiled on Sunday at the Conference on Retroviruses and Opportunistic Infections in Atlanta. Dr Hannah Gay, who cared for the child at the University of Mississippi medical centre, told the Guardian the case amounted to the first "functional cure" of an HIV-infected child. A patient is functionally cured of HIV when standard tests are negative for the virus, but it is likely that a tiny amount remains in their body.
"Now, after at least one year of taking no medicine, this child's blood remains free of virus even on the most sensitive tests available," Gay said.
"We expect that this baby has great chances for a long, healthy life. We are certainly hoping that this approach could lead to the same outcome in many other high-risk babies," she added.
The number of babies born with HIV in developed countries has fallen dramatically with the advent of better drugs and prevention strategies. Typically, women with HIV are given antiretroviral drugs during pregnancy to minimise the amount of virus in their blood. Their newborns go on courses of drugs too, to reduce their risk of infection further. The strategy can stop around 98% of HIV transmission from mother to child.
In the UK and Ireland, around 1,200 children are living with HIV they picked up in the womb, during birth, or while being breastfed. If an infected mother's placenta is healthy, the virus tends not to cross into the child earlier in pregnancy, but can in labour and delivery.
The problem is far more serious in developing countries. In sub-Saharan Africa, around 387,500 children aged 14 and under were receiving antiretroviral therapy in 2010. Many were born with the infection. Nearly 2 million more children of the same age in the region are in need of the drugs.
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In the latest case, the mother was unaware she had HIV until after a standard test came back positive while she was in labour. "She was too near delivery to give even the dose of medicine that we routinely use in labour. So the baby's risk of infection was significantly higher than we usually see," said Gay.
Doctors began treating the baby 30 hours after birth. Unusually, they put the child on a course of three antiretroviral drugs, given as liquids through a syringe. The traditional treatment to try to prevent transmission after birth is a course of a single antiretroviral drug. The doctor opted for the more aggressive treatment because the mother had not received any during her pregnancy.
Several days later, blood drawn from the baby before treatment started showed the child was infected, probably shortly before birth. The doctors continued with the drugs and expected the child to take them for life.
However, within a month of starting therapy, the level of HIV in the baby's blood had fallen so low that routine lab tests failed to detect it.
The mother and baby continued regular clinic visits to the clinic for the next year, but then began to miss appointments, and eventually stopped attending all together. The child had no medication from the age of 18 months, and did not see doctors again until it was nearly two years old.
"We did not see this child at all for a period of about five months," Gay told the Guardian. "When they did return to care aged 23 months, I fully expected that the baby would have a high viral load."
When the mother and child arrived back at the clinic, Gay ordered several HIV tests, and expected the virus to have returned to high levels. But she was stunned by the results. "All of the tests came back negative, very much to my surprise," she said.
The case was so extraordinary, Dr Gay called a colleague, Katherine Luzuriaga, an immunologist at Massachusetts Medical School, who with another scientist, Deborah Persaud at Johns Hopkins Children's Centre in Baltimore, had far more sensitive blood tests to hand. They checked the baby's blood and found traces of HIV, but no viruses that were capable of multiplying.
The team believe the child was cured because the treatment was so potent and given swiftly after birth. The drugs stopped the virus from replicating in short-lived, active immune cells, but another effect was crucial. The drugs also blocked the infection of other, long-lived white blood cells, called CD4, which can harbour HIV for years. These CD4 cells behave like hideouts, and can replace HIV that is lost when active immune cells die.
The treatment would not work in older children or adults because the virus will have already infected their CD4 cells.
"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 Dr Persaud. "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."
Children infected with HIV are given antiretroviral drugs with the intent to treat them for life, and Gay warned that anyone who takes the drugs must remain on them.
"It is far too early for anyone to try stopping effective therapy just to see if the virus comes back," she said.
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Until scientists better understand how they cured the child, Gay emphasised that prevention is the most reliable way to stop babies contracting the virus from infected mothers. "Prevention really is the best cure, and we already have proven strategies that can prevent 98% of newborn infections by identifying and treating HIV-positive women," she said.
Genevieve Edwards, a spokesperson for the Terrence Higgins Trust HIV/Aids charity, said: "This is an interesting case, but I don't think it has implications for the antenatal screening programme in the UK, because it already takes steps to ensure that 98% to 99% of babies born to HIV-positive mothers are born without HIV."
Source: http://www.guardian.co.uk/society/2013/mar/03/us-doctors-cure-child-born-hiv
New Scientist
More HIV 'cured': first a baby, now 14 adults
21:00 14 March 2013 by Andy Coghlan
Two weeks after the revelation that a baby has been "cured" of HIV, reports suggest that a similar treatment can cure some adults too. Early treatment seems crucial, but does not guarantee success.
Asier Sáez-Cirión of the Pasteur Institute's unit for regulation of retroviral infections in Paris analysed 70 people with HIV who had been treated with antiretroviral drugs (ARVs) between 35 days and 10 weeks after infection – much sooner than people are normally treated. All of the participants' drug regimes had been interrupted for one reason or another. For example, some people had made a personal choice to stop taking the drugs, others had been part of a trial of different drug protocols.
Most of the 70 people relapsed when their treatment was interrupted, with the virus rebounding rapidly to pre-treatment levels. But 14 of them – four women and 10 men – were able to stay off of ARVs without relapsing, having taken the drugs for an average of three years.
The 14 adults still have traces of HIV in their blood, but at such low levels that their body can naturally keep it in check without drugs.
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Drugless years On average, the 14 adults have been off medication for seven years. One has gone 10-and-a- half years without drugs. "It's not eradication, but they can clearly live without pills for a very long period of time," says Sáez-Cirión.
Last week, a baby was reported to have been "functionally cured" of HIV after receiving a three- drug regime of ARVs almost immediately after birth. Sáez-Cirión warns that rapid treatment doesn't work for everyone, but the new study reinforces the conclusion that early intervention is important.
"There are three benefits to early treatment," says Sáez-Cirión. "It limits the reservoir of HIV that can persist, limits the diversity of the virus and preserves the immune response to the virus that keeps it in check."
Further analysis confirmed that the 14 adults were not "super-controllers" – the 1 per cent of the population that are naturally resistant to HIV – since they lack the necessary protective genes. Also, natural controllers rapidly suppress their infections, whereas these 14 mostly had severe symptoms which led to their early treatment. "Paradoxically, doing badly helped them do better later," says Sáez-Cirión.
Rapid response The researchers are trying to identify additional factors that could explain why early intervention only works on some people, hopefully extending the scope for more functional cures.
"This whole area is fascinating, and we've been looking very closely at issues of early initiation of treatment, and the potential for functional cures," says Andrew Ball, senior adviser on HIV/AIDS strategy at the World Health Organization in Geneva.
"The big challenge is identifying people very early in their infection," says Ball, adding that many people resist testing because of the stigma and potential discrimination. "There's a good rationale for being tested early, and the latest results may give some encouragement to do that," he says.
Journal reference: PLoS Pathogens, DOI: 10.1371/journal.ppat.1003211
The patients were followed for four years during which time 17 of those taking the preventative drug contracted HIV, while 33 of the people taking the placebo became infected.
Therefore, it was concluded that the drug reduces HIV risk by 50 per cent.
Dr. Jonathan Mermin, director of AIDS prevention for the CDC, told CBS News that ‘this study completes the story’ about how HIV drugs can protect people at highest risk of infection.
Currently, the only HIV prevention drug, which is available for use in the U.S. is Truvada, which is prohibitively expensive at $14,000 a year.
The tenofovir, which was used in the study costs just $360 a year per patient.
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According to researcher, Dr. Michael Martin: ‘We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use.
‘Adherence was a key factor determining efficacy in our trial among people who inject drugs.’
Scientists are also working on an HIV vaccine but the U.S. government recently stopped trials of the experimental vaccine after an independent review found it did not prevent HIV infection or reduce the amount of HIV in the blood.
The research, started in 2009, it is just the latest in a series of failed attempts to develop a vaccine for the virus.
In the U.S. intravenous drug users account for about one in 13 new HIV infections but in the countries of Eastern Europe and central Asia, they make up 80 per cent of those newly infected.
According to the National AIDS Trust 96,000 people in the UK are currently living with HIV. Of these people, 22,600 are thought to be unaware of their infection.
In 2011, only one per cent of people with HIV in the UK died.
The biggest group of HIV positive people in the UK are men who have sex with men - they account for about 40,000 of the HIV infected population.
Source: http://www.ngrguardiannews.com/index.php?option=com_content&view=article&id=124982:hiv- cure-in-us-baby-stimulates-aids-research-in-africa&catid=93:science&Itemid=608
BBC News Health
US HIV baby 'cured' by early drug treatment
A baby girl in the US born with HIV appears to have been cured after very early treatment with standard drug therapy, doctors say.
The Mississippi child is now two-and-a-half years old and has been off medication for about a year with no signs of infection.
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More testing needs to be done to see if the treatment - given within hours of birth - would work for others.
If the girl stays healthy, it would be the world's second reported 'cure'.
Analysis
Michelle RobertsHealth editor, BBC News online
There is currently no cure for HIV.
This latest case of a baby girl in the US who was treated within hours of birth and has since been disease-free off HIV medication does not mean we have found this Holy Grail.
While the findings are encouraging, it remains to be seen if the treatment will provide permanent remission.
Experts also say the same treatment would not work in older children and adults with HIV as the virus will have already become too established.
Public health doctors say prevention is still the best way to beat HIV.
If expectant mothers with HIV are given anti-HIV treatment during pregnancy and then have a low- risk Caesarean delivery and do not breastfeed, their babies have a 98% chance of being HIV negative.
Analysis: A cure for HIV? Dr Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, presented the findings at the Conference on Retroviruses and Opportunistic Infections in Atlanta.
"This is a proof of concept that HIV can be potentially curable in infants," she said.
Cocktail of drugs
In 2007, Timothy Ray Brown became the first person in the world believed to have recovered from HIV.
His infection was eradicated through an elaborate treatment for leukaemia that involved the destruction of his immune system and a stem cell transplant from a donor with a rare genetic mutation that resists HIV infection.
In contrast, the case of the Mississippi baby involved a cocktail of widely available drugs, known as antiretroviral therapy, already used to treat HIV infection in infants.
It suggests the swift treatment wiped out HIV before it could form hideouts in the body.
These so-called reservoirs of dormant cells usually rapidly reinfect anyone who stops medication, said Dr Persaud.
Dr Deborah Persaud, Johns Hopkins Children's Center: "This sets the stage for paediatric care agenda"
The baby was born in a rural hospital where the mother had only just tested positive for HIV infection.
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Because the mother had not been given any prenatal HIV treatment, doctors knew the baby was at high risk of being infected.
Researchers said the baby was then transferred to the University of Mississippi Medical Center in Jackson.
Once there, paediatric HIV specialist Dr Hannah Gay put the infant on a cocktail of three standard HIV-fighting drugs at just 30 hours old, even before laboratory tests came back confirming the infection.
“Start Quote We really can quite confidently conclude at this point that the child does very much appear to be cured”
Dr Rowena JohnstonFoundation for Aids Research
"I just felt like this baby was at higher-than-normal risk and deserved our best shot," Dr Gay said.
The treatment was continued for 18 months, at which point the child disappeared from the medical system. Five months later the mother and child turned up again but had stopped the treatment in this interim.
The doctors carried out tests to see if the virus had returned and were astonished to find that it had not.
Dr Rowena Johnston, of the Foundation for Aids Research, said it appeared that the early intervention that started immediately after birth worked.
"I actually do believe this is very exciting.
"This certainly is the first documented case that we can truly believe from all the testing that has been done.
"Many doctors in six different laboratories all applied different, very sophisticated tests trying to find HIV in this infant and nobody was able to find any.
"And so we really can quite confidently conclude at this point that the child does very much appear to be cured."
A spokeswoman for the HIV/Aids charity the Terrence Higgins Trust said: "This is interesting, but the patient will need careful ongoing follow-up for us to understand the long-term implications for her and any potential for other babies born with HIV."
Source:
http://www.bbc.co.uk/news/world-us-canada-21651225
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AFP
HIV cured in baby for the first time: scientists By Jean-Louis Santini (AFP) – Mar 3, 2013
WASHINGTON — Researchers say they have, for the first time, cured a baby born with HIV -- a development that could help improve treatment of babies infected at birth. There is an important technical nuance: researchers insist on calling it a "functional cure" rather than a complete cure.
That is because the virus is not totally eradicated. Still, its presence is reduced to such a low level that a body can control it without the need for standard drug treatment. The only fully cured AIDS patient recognized worldwide is the so-called "Berlin patient," American Timothy Brown. He is considered cured of HIV and leukemia five years after receiving bone marrow transplants from a rare donor naturally resistant to HIV. The marrow transplant was aimed at treating his leukemia. But in this new case, the baby girl received nothing more invasive or complex than commonly available antiretroviral drugs. The difference, however, was the dosage and the timing: starting less than 30 hours after her birth.
It is that kind of aggressive treatment that likely yielded the "functional cure," researchers reported Sunday at the 20th annual Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta, Georgia.
What researchers call dormant HIV-infected cells often re-start infections in HIV-infected patients within a few weeks after antiretroviral treatment stops, forcing most people who have tested HIV- positive to stay on the drugs for life or risk the illness progressing.
"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 lead researcher Deborah Persaud, of Johns Hopkins Children's Center in Baltimore, Maryland.
It appears to be the first time this was achieved in a baby, she said.
The baby was infected by her HIV-positive mother, and her treatment with therapeutic doses of antiretroviral drugs began even before her own positive blood test came back.
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The typical protocol for high-risk newborns is to give them smaller doses of the drugs until results from an HIV blood test is available at six weeks old.
Tests showed the baby's viral count steadily declined until it could not longer be detected 29 days after her birth.
The child was given follow-up treatment with antiretrovirals until 18 months, at which point doctors lost contact with her for 10 months. During that period she was not taking antiretrovirals.
Researchers then were able to do a series of blood tests -- and none gave an HIV-positive result. Natural viral suppression without treatment is an exceedingly rare occurrence, seen in fewer than half a percent of HIV-infected adults, known as "elite controllers," whose immune systems are able to rein in viral replication and keep the virus at clinically undetectable levels.
Experts on HIV have long wanted to help all HIV patients achieve elite-controller status. Researchers say this new case offers hope as a game-changer, because it suggests prompt antiretroviral therapy in newborns indeed can do that.
Still, they said, their first priority is learning how to stop transmission of the virus from mother to newborn. ARV treatments of mothers currently stop transmission to newborns in 98 percent of cases, they say.
"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 pointed out. The research was funded by the National Institutes of Health and the American Foundation for AIDS Research.
Source: http://www.google.com/hostednews/afp/article/ALeqM5jLpMgEo2FHaTBOQg0nBNVZdoBtew?docI d=CNG.727e0eb3f54ecd51927d4c146e5b1431.91
Reuters
U.S. baby's HIV infection cured through very early treatment
By Julie Steenhuysen CHICAGO | Mon Mar 4, 2013 6:21am GMT
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(Reuters) - A baby girl in Mississippi who was born with HIV has been cured after very early treatment with standard HIV drugs, U.S. researchers reported on Sunday, in a potentially ground- breaking case that could offer insights on how to eradicate HIV infection in its youngest victims. The child's story is the first account of an infant achieving a so-called functional cure, a rare event in which a person achieves remission without the need for drugs and standard blood tests show no signs that the virus is making copies of itself. More testing needs to be done to see if the treatment would have the same effect on other children, but the results could change the way high-risk babies are treated and possibly lead to a cure for children with HIV, the virus that causes AIDS. "This is a proof of concept that HIV can be potentially curable in infants," said Dr. Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, who presented the findings at the Conference on Retroviruses and Opportunistic Infections in Atlanta. The child's story is different from the now famous case of Timothy Ray Brown, the so-called "Berlin patient," whose HIV infection was completely eradicated through an elaborate treatment for leukaemia in 2007 that involved the destruction of his immune system and a stem cell transplant from a donor with a rare genetic mutation that resists HIV infection. "We believe this is our Timothy Brown case to spur research interest toward a cure for HIV infection in children," Persaud said at a news conference. Instead of Brown's costly treatment, however, the case of the Mississippi baby, who was not identified, involved the use of a cocktail of widely available drugs already used to treat HIV infection in infants. When the baby girl was born in a rural hospital in July 2010, her mother had just tested positive for HIV infection. Because her mother had not received any prenatal HIV treatment, doctors knew the child was at high risk of infection. They transferred her to the University of Mississippi Medical Center in Jackson, where she came under the care of Dr. Hannah Gay, a paediatric HIV specialist. Because of her risk, Dr. Gay put the infant on a cocktail of three HIV-fighting drugs - zidovudine (also known as AZT), lamivudine, and nevirapine - when she was just 30 hours old. Two blood tests done within the first 48 hours of the child's life confirmed her infection and she was kept on the full treatment regimen, Persaud told reporters at the conference. In more typical pregnancies, when an HIV-infected mother has been given drugs to reduce the risk of transmission to her child, the baby would only have been given a single drug, nevirapine. Researchers believe use of the more aggressive antiretroviral treatment when the child was just days old likely resulted in her cure by keeping the virus from forming hard-to-treat pools of cells known as viral reservoirs, which lie dormant and out of the reach of standard medications. These reservoirs rekindle HIV infection in patients who stop therapy, and they are the reason most HIV- infected individuals need lifelong treatment to keep the infection at bay. 10-MONTH GAP After starting on treatment, the baby's immune system responded and tests showed diminishing levels of the virus until it was undetectable 29 days after birth. The baby received regular treatment for 18 months, but then stopped coming to appointments for a period of about 10 months, when her mother said she was not given any treatment. The doctors did not say why the mother stopped coming. When the child came back under the care of Dr. Gay, she ordered standard blood tests to see how the child was faring before resuming antiviral therapy.
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What she found was surprising. The first blood test did not turn up any detectible levels of HIV. Neither did the second. And tests for HIV-specific antibodies, the standard clinical indicator of HIV infection, also remained negative. "At that point, I knew I was dealing with a very unusual case," Dr. Gay said. Baffled, Dr. Gay turned to her friend and long-time colleague, Dr. Katherine Luzuriaga of the University of Massachusetts, and she and Persaud did a series of sophisticated lab tests on the child's blood. The first looked for silent reservoirs of the virus where it remains dormant but can replicate if activated. That is detected in a type of immune cell known as a CD4 T-cell. After culturing the child's cells, they found no sign of the virus. Then, the team looked for HIV DNA, which indicates that the virus has integrated itself into the genetic material of the infected person. This test turned up such low levels that it was just above the limit of the test's ability to detect it. The third test looked for bits of genetic material known as viral RNA. They only found a single copy of viral RNA in one of the two tests they ran. Because there is no detectible virus in the child's blood, the team has advised that she not be given antiretroviral therapy, whose goal is to block the virus from replicating in the blood. Instead, she will be monitored closely. There are no samples that can be used by other researchers to confirm the findings, which may lead sceptics to challenge how the doctors know for sure that the child was infected. Persaud said the team is trying to use the tiny scraps of viral genetic material they have been able to gather from the child to compare with the mother's infection, to confirm that the child's infection came from her mother. But, she stressed, the baby had tested positive in two separate blood tests, and there had been evidence of the virus replicating in her blood, which are standard methods of confirming HIV infection. ADDITIONAL RESEARCH Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, said although tools to prevent transmission of HIV to infants are available, many children are born infected. "With this case, it appears we may have not only a positive outcome for the particular child, but also a promising lead for additional research toward curing other children," he said. Dr. Rowena Johnston, vice president and director of research for amfAR, The Foundation for AIDS Research, which helped fund the study, said the fact that the cure was achieved by antiretroviral therapy alone makes it "imperative that we learn more about a newborn's immune system, how it differs from an adult's and what factors made it possible for the child to be cured." Because the child's treatment was stopped, the doctors were able to determine that this child had been cured, raising questions about whether other children who received early treatment and have undetectable viral loads may also be cured without their doctors knowing it. But the doctors warned parents not to be tempted to take their children off treatment to see if the virus comes back. Normally, when patients stop taking their medications, the virus comes roaring back, and treatment interruptions increase the risk that the virus will develop drug resistance. "We don't want that," Dr. Gay said. "Patients who are on successful therapy need to stay on their successful therapy until we figure out a whole lot more about what was going on with this child and what we can do for others in the future."
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The researchers are trying to find biomarkers that would offer a rationale to consider stopping therapy within the context of a clinical trial. If they can learn what caused the child to clear her virus, they hope to replicate that in other babies, and eventually learn to routinely cure infections. (Editing by Jilian Mincer, Sandra Malerand Mohammad Zargham)
Source: http://uk.reuters.com/article/2013/03/04/uk-hiv-infant-cure-idUKBRE92303L20130304
AP
SCIENTISTS SAY BABY BORN WITH HIV APPARENTLY CURED By LAURAN NEERGAARD
— Mar. 4 2:30 PM EST
WASHINGTON (AP) — A baby born with the virus that causes AIDS appears to have been cured, scientists announced Sunday, describing the case of a child from Mississippi who's now 2½ and has been off medication for about a year with no signs of infection. There's no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus' genetic material still lingering. If so, it would mark only the world's second reported cure.
Specialists say Sunday's announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.
"You could call this about as close to a cure, if not a cure, that we've seen," Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.
A doctor gave this baby faster and stronger treatment than is usual, starting a three-drug infusion within 30 hours of birth. That was before tests confirmed the infant was infected and not just at risk from a mother whose HIV wasn't diagnosed until she was in labor.
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"I just felt like this baby was at higher-than-normal risk, and deserved our best shot," Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi, said in an interview.
That fast action apparently knocked out HIV in the baby's blood before it could form hideouts in the body. Those so-called reservoirs of dormant cells usually rapidly reinfect anyone who stops medication, said Dr. Deborah Persaud of Johns Hopkins Children's Center. She led the investigation that deemed the child "functionally cured," meaning in long-term remission even if all traces of the virus haven't been completely eradicated.
Next, Persaud's team is planning a study to try to prove that, with more aggressive treatment of other high-risk babies. "Maybe we'll be able to block this reservoir seeding," Persaud said.
No one should stop anti-AIDS drugs as a result of this case, Fauci cautioned.
But "it opens up a lot of doors" to research if other children can be helped, he said. "It makes perfect sense what happened."
Better than treatment is to prevent babies from being born with HIV in the first place.
About 300,000 children were born with HIV in 2011, mostly in poor countries where only about 60 percent of infected pregnant women get treatment that can keep them from passing the virus to their babies. In the U.S., such births are very rare because HIV testing and treatment long have been part of prenatal care.
"We can't promise to cure babies who are infected. We can promise to prevent the vast majority of transmissions if the moms are tested during every pregnancy," Gay stressed.
The only other person considered cured of the AIDS virus underwent a very different and risky kind of treatment — a bone marrow transplant from a special donor, one of the rare people who is naturally resistant to HIV. Timothy Ray Brown of San Francisco has not needed HIV medications in the five years since that transplant.
The Mississippi case shows "there may be different cures for different populations of HIV-infected people," said Dr. Rowena Johnston of amFAR, the Foundation for AIDS Research. That group funded Persaud's team to explore possible cases of pediatric cures.
It also suggests that scientists should look back at other children who've been treated since shortly after birth, including some reports of possible cures in the late 1990s that were dismissed at the time, said Dr. Steven Deeks of the University of California, San Francisco, who also has seen the findings.
"This will likely inspire the field, make people more optimistic that this is possible," he said.
In the Mississippi case, the mother had had no prenatal care when she came to a rural emergency room in advanced labor. A rapid test detected HIV. In such cases, doctors typically give the newborn low-dose medication in hopes of preventing HIV from taking root. But the small hospital didn't have
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The child responded well through age 18 months, when the family temporarily quit returning and stopped treatment, researchers said. When they returned several months later, remarkably, Gay's standard tests detected no virus in the child's blood.
Ten months after treatment stopped, a battery of super-sensitive tests at half a dozen laboratories found no sign of the virus' return. There were only some remnants of genetic material that don't appear able to replicate, Persaud said.
In Mississippi, Gay gives the child a check-up every few months: "I just check for the virus and keep praying that it stays gone."
The mother's HIV is being controlled with medication and she is "quite excited for her child," Gay added.
The United Nations agency that guides the global fight against HIV/AIDS, known as UNAIDS, hailed the news.
"This news gives us great hope that a cure for HIV in children is possible and could bring us one step closer to an AIDS-free generation," said UNAIDS Executive Director Michel Sidibe. "This also underscores the need for research and innovation especially in the area of early diagnostics."
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Associated Press writer Ron DePasquale contributed from the United Nations in New York.
Source: http://bigstory.ap.org/article/scientists-say-baby-born-hiv-apparently-cured-0
The New York Times
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In Medical First, a Baby With H.I.V. Is Deemed Cured By ANDREW POLLACK and DONALD G. McNEIL Jr. Published: March 3, 2013 158 Comments
Doctors announced on Sunday that a baby had been cured of anH.I.V. infection for the first time, a startling development that could change how infected newborns are treated and sharply reduce the number of children living with the virus that causes AIDS. Related
The baby, born in rural Mississippi, was treated aggressively with antiretroviral drugs starting around 30 hours after birth, something that is not usually done. If further study shows this works in other babies, it will almost certainly be recommended globally. The United Nations estimates that 330,000 babies were newly infected in 2011, the most recent year for which there is data, and that more than three million children globally are living with H.I.V.
If the report is confirmed, the child born in Mississippi would be only the second well-documented case of a cure in the world. That could give a lift to research aimed at a cure, something that only a few years ago was thought to be virtually impossible, though some experts said the findings in the baby would probably not be relevant to adults.
The first person cured was Timothy Brown, known as the Berlin patient, a middle-aged man with leukemia who received a bone-marrow transplant from a donor genetically resistant to H.I.V. infection.
“For pediatrics, this is our Timothy Brown,” said Dr. Deborah Persaud, associate professor at the Johns Hopkins Children’s Center and lead author of the report on the baby. “It’s proof of principle that we can cure H.I.V. infection if we can replicate this case.”
Dr. Persaud and other researchers spoke in advance of a presentation of the findings on Monday at the Conference on Retroviruses and Opportunistic Infections in Atlanta. The results have not yet been published in a peer-reviewed medical journal.
Some outside experts, who have not yet heard all the details, said they needed convincing that the baby had truly been infected. If not, this would be a case of prevention, something already done for babies born to infected mothers.
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“The one uncertainty is really definitive evidence that the child was indeed infected,” said Dr. Daniel R. Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital in Boston.
Dr. Persaud and some other outside scientists said they were certain the baby — whose name and gender were not disclosed — had been infected. There were five positive tests in the baby’s first month of life — four for viral RNA and one for DNA. And once the treatment started, the virus levels in the baby’s blood declined in the pattern characteristic of infected patients.
Dr. Persaud said there was also little doubt that the child experienced what she called a “functional cure.” Now 2 1/2, the child has been off drugs for a year with no sign of functioning virus.
The mother arrived at a rural hospital in the fall of 2010 already in labor and gave birth prematurely. She had not seen a doctor during the pregnancy and did not know she had H.I.V. When a test showed the mother might be infected, the hospital transferred the baby to the University of Mississippi Medical Center, where it arrived at about 30 hours old.
Dr. Hannah B. Gay, an associate professor of pediatrics, ordered two blood draws an hour apart to test for the presence of the virus’ RNA and DNA.
The tests found a level of virus at about 20,000 copies per milliliter, fairly low for a baby. But since tests so early in life were positive, it suggests the infection occurred in the womb rather than during delivery, Dr. Gay said.
Typically a newborn with an infected mother would be given one or two drugs as a prophylactic measure. But Dr. Gay said that based on her experience, she almost immediately used a three-drug regimen aimed at treatment, not prophylaxis, not even waiting for the test results confirming infection.
Virus levels rapidly declined with treatment and were undetectable by the time the baby was a month old. That remained the case until the baby was 18 months old, after which the mother stopped coming to the hospital and stopped giving the drugs.
When the mother and child returned five months later, Dr. Gay expected to see high viral loads in the baby. But the tests were negative.
Suspecting a laboratory error, she ordered more tests. “To my greater surprise, all of these came back negative,” Dr. Gay said.
Dr. Gay contacted Dr. Katherine Luzuriaga, an immunologist at the University of Massachusetts, who was working with Dr. Persaud and others on a project to document possible pediatric cures. The researchers, sponsored by amfAR, the Foundation for AIDS Research, put the baby through a battery
17 of sophisticated tests. They found tiny amounts of some viral genetic material but no virus able to replicate, even lying dormant in so-called reservoirs in the body.
There have been scattered cases reported in the past, including one in The New England Journal of Medicine in 1995, of babies clearing the virus, even without treatment.
Those reports were greeted skeptically, particularly since testing methods were not very sophisticated back then. But those reports and this new one could suggest there is something different about babies’ immune systems, said Dr. Joseph McCune of the University of California, San Francisco.
One hypothesis is that the drugs killed off the virus before it could establish a hidden reservoir in the baby. One reason people cannot be cured now is that the virus hides in a dormant state, out of reach of existing drugs. When drug therapy is stopped, the virus can emerge from hiding.
“That goes along with the concept that, if you treat before the virus has had an opportunity to establish a large reservoir and before it can destroy the immune system, there’s a chance you can withdraw therapy and have no virus,” said Dr. Anthony S. Fauci, the director of the National Institute for Allergy and Infectious Diseases. Adults, however, typically do not know they are infected right as it happens, he said.
Dr. Steven Deeks, professor of medicine at the University of California, San Francisco, said if the reservoir never established itself, then he would not call it a true cure, though this was somewhat a matter of semantics. “Was there enough time for a latent reservoir, the true barrier to cure, to establish itself?” he said.
Still, he and others said, the results could lead to a new protocol for quickly testing and treating infants.
In the United States, transmission from mother to child is rare — several experts said there are only about 200 cases a year or even fewer — because infected mothers are generally treated during their pregnancies.
If the mother has been treated during pregnancy, babies are typically given six weeks of prophylactic treatment with one drug, AZT, while being tested for infection. In cases like the Mississippi one, where the mother was not treated during pregnancy, standards have been changing, but typically two drugs are used.
But women in many developing countries are less likely to be treated during pregnancy. And in South Africa and other African countries that lack sophisticated testing, babies born to infected mothers are often not tested until after six weeks, said Dr. Yvonne Bryson, chief of global pediatric infectious disease at the University of California, Los Angeles.
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Dr. Bryson, who was not involved in the Mississippi work, said she was certain the baby had been infected and called the finding “one of the most exciting things I’ve heard in a long time.”
Studies are being planned to see if early testing and aggressive treatment can work for other babies. While the bone marrow transplant that cured Mr. Brown is an arduous and life-threatening procedure, the Mississippi treatment is not and could become a new standard of care.
While it might be difficult for some poorer countries to do, treating for only a year or two would be cost effective, “sparing the kid a lifetime of antiretroviral therapy,” said Rowena Johnston, director of research at amfAR.
Source: http://www.nytimes.com/2013/03/04/health/for-first-time-baby-cured-of-hiv-doctors- say.html?pagewanted=all&_r=0
The Washington Post
Baby born with HIV is apparently cured with aggressive drug treatment A baby born with the AIDS virus two years ago in Mississippi who was put on antiretroviral therapy within hours of birth appears to have been cured of the infection, researchers said Sunday at a scientific conference in Atlanta.
Whether the cure is complete and permanent, or only partial and long-lasting, is not certain. Either way, the highly unusual case raises hope for the more than 300,000 babies born with the infection around the world each year.
Hannah Berry Gay is a former missionary in Ethiopia and a mother of four who dislikes the spotlight. AIDS researchers, health officials weigh report of baby’s cure
David Brown MAR 5
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Scientists and advocates are trying to determine the importance of the treatment of a child born with HIV.
If the findings in the new case bear up under further scrutiny, it will mark the first time the infection has been cured by drugs. The only known cure of a case of HIV infection occurred in 2007. An American man living in Germany got a bone-marrow transplant from a donor who had a rare HIV- resistance mutation in his cells.
“We are calling this a ‘functional cure,’ ” said Katherine Luzuriaga, a physician at the University of Massachusetts Medical School, who was involved in the baby’s care. “Time and further investigation will tell us whether this child actually has been cured or not.”
Researchers provided no personal details about the case, not even the sex of the infant.
Word of the case was being greeted with interest and skepticism by researchers, who have seen many other reports of cure prove false when examined closely or tried again.
“It’s a hypothesis-generating case,” Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, said of the Mississippi case. “It will give us some food for thought about studies that need to be done to see if this is a real phenomenon.”
Treating a newborn with the life-extending combination of drugs known as “triple therapy” is almost never done.
The reason is that it is difficult to determine immediately after birth whether a baby is infected. Antibodies from an HIV-infected mother spill into the baby’s circulation, giving a positive test for weeks. Infants are not started on the drugs until at least six weeks after birth, when infection is certain.
Mother-to-child HIV transmission is extremely rare in the United States. Fewer than 200 cases occur each year. For more than 15 years, virtually all pregnant women known to be infected have been given antiretroviral drugs during pregnancy and labor. Their babies get one or two drugs for at least six weeks after birth — a strategy that cuts the risk of transmission to less than 5 percent.
In the Mississippi case, however, the mother arrived at the hospital without prenatal care. When a screening test for HIV came back positive, “she was too near delivery to give even the dose of medicine that we routinely use during labor,” Hannah Gay, a pediatrician at the University of Mississippi Medical Center in Jackson, wrote in a short narrative of the events provided to a reporter.
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Because of the baby’s unusually high risk of having been infected, Gay and her colleagues started full triple therapy 30 hours after birth.
HIV tests of the infant’s blood over the next three weeks were repeatedly positive. The virus could have been from the mother, although such spillover is usually cleared quickly by the baby. Instead, the amount of HIV — the “viral load” — declined steadily over time, as happens in adults with long- established infections when they are started on triple therapy. By 29 days after birth, the baby had no detectable virus, which is the goal of treatment.
Source: http://www.washingtonpost.com/hiv-infected-infant-cured-in-mississippi/2013/03/04/e921eefa- 84cf-11e2-a80b-3edc779b676f_video.html
Los Angeles Times
Child born with HIV is 'functionally cured' Doctors say the girl, now 2, has only trace amounts of HIV in her bloodstream and has been able to keep the virus in check without medication. The next step is to try to replicate the results. March 03, 2013|By Eryn Brown and Karen Kaplan, Los Angeles Times
For the first time, doctors are reporting that a child born with HIV and put on an unusually aggressive treatment regimen has been functionally cured of the infection.
Now 2 years old, the Mississippi girl has only trace amounts of HIV in her bloodstream and has been able to keep the virus that causes AIDS in check without the help of medication, doctors said Sunday at a medical conference in Atlanta.
If researchers demonstrate that the same treatment can work in other children, it could drastically alter the lives of the estimated 1,000 babies born with HIV every day, most of them in Africa, doctors said.
"If there is a trial that shows this can happen again, then this will be very important," said Dr. Karin Nielsen, a pediatrician who specializes in infectious diseases at UCLA's David Geffen School of Medicine who was not involved in the girl's case. "You'll be able to treat people very intensively and reverse the disease."
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Attempting to replicate the results in other HIV-positive infants is "our next step," said Dr. Deborah Persaud, a virologist at Johns Hopkins Children's Center who described the Mississippi patient at the Conference on Retroviruses and Opportunistic Infections. She and others are to make a formal presentation during the conference's scientific program Monday.
Details of the unusual case have not yet been published in a medical journal so that other doctors and researchers can assess it. It's possible that the girl — although at high risk for contracting the virus from her mother — was not actually infected herself, skeptics said.
Researchers who have examined her case extensively say they believe she did have the virus but was able to knock it back before it had time to establish itself in parts of the immune system where it can remain dormant and strike again after drug treatments are stopped. Such viral reservoirs are essentially impossible to treat once they have been established.
"Is it possible the child was not infected? Yes. Is it likely? No," said Dr. Anthony Fauci, head of the National Institute for Allergies and Infectious Diseases. The virus probably could not have remained in the baby's body as long as it had if she had not been infected, he said.
In the United States and other developed countries, more than 98% of babies born to mothers with HIV do not get the virus thanks to preventive treatments that begin before birth and last up to six weeks afterward. In this case, the girl's mother did not know she had HIV until she took a screening test after she was already in labor, said Dr. Hannah Gay, the pediatric HIV specialist at the University of Mississippi Medical Center in Jackson who treated the baby.
Instead of giving the newborn just one antiretroviral drug, Gay opted for a three-drug regimen that is sometimes given as a long-term treatment for infected babies, she said. The first infusion was begun when the girl was only 30 hours old — several days before blood tests confirmed she was HIV- positive at birth, Gay said.
With continued treatment, it took less than a month for the girl's viral load to become undetectable with standard clinical tests, Gay said.
The treatments continued normally for about 15 months, then became sporadic. When the girl was 18 months old, her mother stopped bringing her to the doctor and she didn't receive her medications.
Five months later, the girl returned to the clinic and had her blood drawn. Gay said she expected to find that her viral load was high. Instead, her HIV levels were still undetectable. Additional tests a few days later confirmed the results, Gay said.
That's when Persaud and Dr. Katherine Luzuriaga, an immunologist at the University of Massachusetts Medical School, began studying the girl's blood. Using the most sensitive tests available, they were able to find tiny amounts of HIV "particles" but no virus capable of replicating, the research team reported.
The analysis was funded by the National Institutes of Health and amfAR, the Foundation for AIDS Research.
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Among adults with HIV, a lucky few — less than 1 in 200 — are able to keep the virus at bay without the help of medications. But this girl is not one of these "elite controllers," Fauci said, because in her case doctors could not detect the presence of any virus capable of replication at all.
"You can always isolate virus from elite controllers," he said. "It's just that they control it so well, it doesn't replicate."
The case of the Mississippi patient is unusual because doctors would not stop a patient's treatment intentionally to see how he or she would fare without antiretroviral drugs. It is also unusual, Fauci said, because most pregnant women in the U.S. who are HIV-positive receive prenatal treatment to fight the virus, which dramatically decreases the risk of transferring the infection to the baby.
Source: http://articles.latimes.com/2013/mar/03/science/la-sci-aids-baby-20130304
Nature
Infant's vanquished HIV leaves doctors puzzled
Clinical trials are planned to test whether very early therapy can control infection in others.
Erika Check Hayden 05 March 2013
Hungry for more details about the child who has apparently been cured of HIV, researchers are puzzling over how it happened and the possible implications for other patients.
Deborah Persaud, a virologist at the Johns Hopkins Children's Center in Baltimore, Maryland, described the case of the child on 4 March at the 20th annual Conference on Retroviruses and Opportunistic Infections in Atlanta, Georgia.
“This takes some tools that we’re using anyway and uses them to accomplish our big goal,” says Ron Swanstrom, a virologist at the University of North Carolina at Chapel Hill. “This is highly significant.”
Doctors started treating the baby, who was born to an HIV-positive mother, before the infant was 30 hours old. Treatment continued for 18 months, until the child's family stopped it. When doctors in Mississippi saw the child 10 months later, they worked with researchers including Persaud to confirm that there was no virus detectable in the infant's blood.
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Persaud says that the child, now 2.5 years old and not taking medication, is still healthy — although tests show that viral DNA remains.
The child is one of only two people known to have been 'functionally' cured of HIV. It is difficult to prove that people with functional cures ever completely clear HIV from their bodies, but they effectively control the virus, and their immune systems stay healthy without treatment.
Timothy Ray Brown, known as the 'Berlin patient', was the first person known to have been cured of HIV: doctors reported in 2008 that he was given a bone-marrow transplant that replaced his own immune cells with cells invulnerable to the virus, and achieved a functional cure. But the technique is deemed too risky for most people with HIV.
It is not clear how the antiretroviral drugs cured the infant. Persaud says that part of the answer probably lies in starting the treatment very early, and in using more drugs than are usually given to infants born to HIV-positive mothers.
It was already known that treating a pregnant woman who has HIV can prevent her child from ever becoming infected, but the latest finding shows that if this is not done, “there is enough rationale to think that very early therapy may accomplish this [cure] in more than one infant”, says Persaud.
Persaud says she is planning clinical trials to test her hypothesis. But for now, the World Health Organization said that it will not change its guidance to provide antiretroival treatment to HIV- positive women and to their babies, to prevent the infants from becoming infected. “The implications of this case study are not very clear at this point until more information becomes available,” the organization said in a statement.
Early intervention Robert Siliciano, a molecular biologist at Johns Hopkins University, says that the infant probably received treatment before making any memory T cells — immune cells that can harbour HIV indefinitely. Because of this, Siliciano says, “there was no stable reservoir for the virus, and after a couple of months, she seemed to be cured”.
Other researchers, however, point out that it is difficult to subject a toddler to an in-depth study of cells and tissues as was done for Brown, so it may be difficult to verify the cure or determine its mechanism. Indeed, Swanstrom says, the child may be an 'elite controller' — one of the rare people whose immune system is naturally able to keep the virus in check. And it is unlikely that many other people could be cured in this way: in adults, starting treatment even as soon as two weeks after infection does not provide a cure.
But the case is an important demonstration to researchers who are searching for strategies to cure people with HIV. “It’s nice to think that if you prevent establishment of the reservoir, this disease becomes curable,” says Siliciano.
Source: http://www.nature.com/news/infant-s-vanquished-hiv-leaves-doctors-puzzled-1.12531
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Science News
Baby may be cured of HIV Only viral traces remain after prompt treatment of newborn, suggesting no working virus is left in the girl’s body
By Nathan Seppa
Web edition: March 4, 2013
An infant born with HIV has cleared her body of the virus with the help of three medications started shortly after birth, scientists reported March 3 at the Conference on Retroviral and Opportunistic Infections in Atlanta.
On its face, the case looks like the first time an infant has ever wiped out the pathogen as well as the first time a person has been cured with drugs. The virus was thwarted in the girl, now 2 1/2 years old, with the help of more drugs than a newborn usually gets.
But some researchers caution that it remains unclear whether the virus had taken hold and infected the child or whether the child merely carried the virus from her mother.
“There’s no question the baby was exposed,” says Daniel Kuritzkes, a virologist at Harvard Medical School and Brigham and Women’s Hospital in Boston, who wasn’t involved in the case. “It’s a little less easy to determine whether the child was actually infected.”
Previously, the only person cured of HIV infection was a man in Berlin who vanquished the virus after getting a bone marrow transplant from a person with a specific gene mutation that makes cells resistant to the virus.
Either way, Kuritzkes says, the difference between “exposed” and “infected” might prove semantic if further research supports the idea of stopping childhood HIV by giving at-risk newborns the three antiretroviral drugs. The standard care starts with a preventive dose of one drug for a week and another for six weeks.
Virologist Deborah Persaud of Johns Hopkins University, who presented the data, and her colleagues suggest that prompt use of the triple therapy knocked out HIV in this child by intercepting the virus before it could create reservoirs in the body that are unreachable by drugs.
The mother of the Mississippi child was unaware until giving birth that she was infected and hadn’t been taking anti-HIV drugs during pregnancy. This lack of prenatal antiretroviral care, and a positive test for HIV in the mother and baby, prompted Hannah Gay, a University of Mississippi pediatrician
25 who supervised the treatment, to prescribe a therapeutic triple therapy for the child as soon as possible, which turned out to be 30 hours after birth.
The baby’s blood continued to test positive for HIV at days 7, 12 and 20. But on day 29 a test came back negative. The baby stayed on the triple drug regimen until she was 18 months old, at which point the mother stopped bringing the baby in for doctor’s visits.
Several months later, the child was tested and found to be “functionally cured,” a term signifying that doctors were unable to locate any replicating HIV in her body. All that remained was viral fragments, even though the child hadn’t been receiving medication.
Whether the treatment used in the Mississippi child could serve as a model for therapy for newborns with HIV remains unknown. Mother-to-child HIV transmission has become uncommon in the United States, with perhaps 200 cases per year or fewer, thanks to preventive drug regimens during pregnancy and in newborns. It still occurs frequently elsewhere, with some 300,000 HIV- infected births every year.
"People are really quite intrigued by this report,” Kuritzkes says.
Source: http://www.sciencenews.org/view/generic/id/348710/description/Baby_may_be_cured_of_HIV
Channel 4
HIV baby 'cured' by early drug treatment
In a potentially huge breakthrough for the treatment of Aids, US scientists say a two-year-old baby born with the HIV virus has remained healthy with no medication for a year after drug treatment.
Specialists say the announcement by US scientists, made at a major Aids meeting in Atlanta on Sunday, offers promising clues for efforts to eliminate HIV infection in children, especially in Aids- plagued countries where too many babies are born with the virus.
There is no guarantee the child from Mississippi will remain healthy, although sophisticated testing has uncovered just traces of the virus' genetic material.
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If the two-year-old girl remains healthy, it would mark only the world's second reported cure.
A doctor gave the baby faster and stronger treatment than is usual, starting a three-drug infusion within 30 hours of birth. The treatment began even before tests confirmed the infant was infected and not just at risk from a mother whose HIV wasn't diagnosed until she was in labour.
The early intervention appeared to knock out HIV in the baby's blood before it could form hideouts in the body.
Those so-called reservoirs of dormant cells usually rapidly reinfect anyone who stops medication, said Dr Deborah Persaud of Johns Hopkins Children's Centre.
'Functionally cured'
She led the investigation that deemed the child "functionally cured," meaning in long-term remission even if all traces of the virus have not been completely eradicated.
Dr Persaud's team is planning a study to try to prove the success could be replicated with more aggressive treatment of other high-risk babies.
"You could call this about as close to a cure, if not a cure, that we've seen," said Dr Anthony Fauci of the National Institutes of Health
You could call this about as close to a cure, if not a cure, that we've seen.Dr Anthony Fauci, National Institutes of Health
He cautioned that no-one should stop anti-Aids drugs as a result of this case, but added that "it opens up a lot of doors" to research if other children can be helped.
About 300,000 children were born with HIV in 2011, mostly in developing countries where only about 60 per cent of infected pregnant women get treatment that can keep them from passing the virus to their babies.
In the US such births are very rare because HIV testing and treatment long have been part of prenatal care.
Source: http://www.channel4.com/news/hiv-baby-cured-by-early-drug-treatment
NRP
27
Scientists believe a little girl born with HIV has been cured of the infection.
She's the first child and only the second person in the world known to have been cured since the virus touched off a global pandemic nearly 32 years ago.
Doctors aren't releasing the child's name, but we know she was born in Mississippi and is now 2 1/2 years old — and healthy. Scientists presented details of the case Sunday at a scientific conference in Atlanta.
The case has big implications. While fewer than 130 such children are born each year in the U.S., an estimated 330,000 children around the world get infected with HIV at or around birth every year, most of them in sub-Saharan Africa.
And while many countries are striving to prevent these mother-to-child infections, many thousands of children will certainly get infected in coming years.
Until now, such children have been considered permanently infected. Specialists thought they needed lifelong antiviral drugs to prevent HIV from destroying their immune system and killing them via AIDS.
The Mississippi child's surprising cure came about from happenstance — and the quick thinking of a University of Mississippi pediatric infectious disease specialist, Hannah Gay.
"The child came to our attention as a high-risk exposure to maternal HIV," Gay tells Shots. Her mother hadn't had any prenatal care, she says, so didn't get antiviral drugs during pregnancy.
The fact that the newborn tested positive for HIV within 30 hours of birth is a sign she was probably infected in utero, HIV specialists say.
Gay decided to begin treating the child immediately, with the first dose of antivirals given within 31 hours of birth. That's faster than most infants born with HIV get treated, and specialists think it's one important factor in the child's cure.
In addition, Gay gave higher-than-usual, "therapeutic" doses of three powerful HIV drugs rather than the "prophylactic" doses usually given in these circumstances.
Over the months, the baby thrived, and standard tests could detect no virus in her blood, which is the normal result from antiviral treatment.
Then, her mother stopped bringing the child in for checkups.
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"The baby's mom was having some life changes, that's about all I can say," Gay reports. "I saw her at 18 months, and then after that did not see her for several months. And we were unable to locate her for a while."
Gay enlisted the help of Mississippi state health authorities to track down the child. When they found her, the mother said she had stopped giving the child antiviral drugs six or seven months earlier.
At that point, Gay expected to find that the child's blood was teeming with HIV. But to her astonishment, tests couldn't find any virus.
"My first thought was, 'Oh, my goodness, I've been treating a child who's not actually infected,' " Gay says. But a look at the earlier blood work confirmed the child had been infected with HIV at birth. So Gay then thought the lab must have made a mistake with the new blood samples. So she ran those tests again.
"When all those came back negative, I knew something odd was afoot," Gay says. She contacted an old friend, Dr. Katherine Luzuriaga at the University of Massachusetts, who has been studying pediatric HIV/AIDS for two decades. That was last August. Since then, Luzuriaga's lab and labs in San Diego, Baltimore andBethesda, Md., have run ultra-sensitive tests on the baby's blood. A couple of tests have intermittently found pieces of HIV DNA and RNA, but no evidence that the virus is actively replicating in the child's cells.
Luzuriaga tells Shots this amounts to what's called a "functional cure."
She says that "means control of viral replication and lack of rebound once they come off antiretroviral medications."
The only other such case known to AIDS researchers is the so-called Berlin patient — Timothy Brown of San Francisco. But his treatment involved a bone marrow transplant in Germany — essentially, he was given the immune system of a donor who's genetically resistant to HIV. That's not something that can be easily duplicated. By contrast, the Mississippi child's cure involved readily available medications.
Luzuriaga says researchers believe they have ruled out other possible reasons for the unexpected cure. For instance, the mother did not have a less virulent strain of HIV. And the child does not have known mutations in her immunity genes that confer protection against HIV.
"We think it was that very early and aggressive treatment," she says, "that curtailed the formation of viral reservoirs" — that is, hideouts for the virus within the child's immune cells.
Previous research indicates that once these hideouts are established, it can take 70 years or more of steady, three-drug antiviral treatment to eliminate them. Luzuriaga says the toddler's cure has electrified researchers searching for an HIV cure.
"It's exciting to us," she says. "Because if we were able to replicate this, I think it would be very good news."
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Dr. Deborah Persaud of Johns Hopkins University Medical School, who presented the case at the Conference on Retroviruses and Opportunistic Infections, calls the Mississippi cure "definitely a game-changer."
"This case is sort of the inspiration and provides the rationale to really move forward," Persaud tells Shots.
Kevin Robert Frost of the Foundation for AIDS Research, or amfAR, agrees that the finding will stimulate a lot of further work. The group helped fund studies to determine if the Mississippi toddler is really cured.
"If this approach is proven effective, we could dramatically change the way children born with HIV are treated," he tells Shots.
Plans are under way to mount studies to see if early, aggressive treatment can cure other children of HIV. But Persaud says it will be awhile before researchers can figure out when it might be safe to stop antiviral drugs deliberately.
This research will undboubtedly be high-priority, given the birth of nearly 1,000 HIV- infected newborns a day in the developing world.
AIDS researchers foresee a day when the same treatment could give many of these children a lifetime free of toxic and costly antiviral drugs.
Source: http://www.npr.org/blogs/health/2013/03/04/173258954/scientists-report-first-cure-of-hiv-in-a- child-say-its-a-game-changer
Le Monde
L'annonce, dimanche 3 mars, par une équipe américaine de la première guérison "fonctionnelle" d'un bébé né porteur d'une infection par le virus du sida (VIH), transmis par sa mère, a suscité de nombreuses réactions mêlant espoir et prudence. L'histoire de ce bébé, né dans une zone rurale du Mississippi et à présent âgé de deux ans et demi, est en effet étonnante. Son nom et son sexe n'ont pas été divulgués par le docteur Deborah Persaud, virologue au centrepédiatrique de l'Université Johns Hopkins dans le Maryland, principale auteure de l'étude sur ce premier cas de guérison "fonctionnelle" du sida.
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A l'automne 2010, la mère de l'enfant s'est présentée dans un hôpital rural alors que le travail avait déjà commencé. Elle n'avait pas consulté de médecin au cours de sa grossesse et elle ignorait qu'elle vivait avec le VIH. Lorsque le test pratiqué à son arrivée a détecté cette infection et donc un risque de transmission du virus au nouveau-né, l'équipe hospitalière a transféré ce dernier à l'hôpital de l'Université du Mississippi, où il a été accueilli trente heures après sa naissance. Les tests sanguins effectués sur le bébé ont montré la présence de matériel génétique du virus et une concentration (charge virale) d'environ 20 000 copies du virus par millilitre de sang. Un test positif si précocement après la naissance laisse penserque l'infection ne s'est pas produite lors de l'accouchement mais plus tôt au cours de la grossesse.
L'équipe hospitalière a pris l'initiative de donner à l'enfant, non pas un ou deux médicaments antirétroviraux comme c'est la règle, mais directement une trithérapie, combinant trois molécules différentes. Au bout d'un mois, la charge virale était devenue indétectable chez le bébé, c'est-à-dire que le nombre de copies du virus dans le sang est inférieur à 1000 par millilitre de sang. Après 18 mois de traitement, la mère a cessé de conduire l'enfant à l'hôpital et de lui donnerses médicaments, avant de se présenter à nouveau cinq mois plus tard. Les nouveaux tests pratiqués par les médecins ont surpris et ont fait soupçonner une erreur du laboratoire d'analyse puisque la charge virale demeurait indétectable. Seules de petites quantités de matériel génétique du VIH étaient décelables.
PAS EN AVANT
L'enfant est toujours porteur du virus, mais celui-ci ne paraît pas capable de se répliquer. D'où le terme de "guérison fonctionnelle" employé par l'équipe médicale, puisque la guérison complète supposerait l'éradication complète du virus de l'organisme. La mise très rapide sous traitement intensif contre le VIH expliquerait un tel résultat, mais il reste à démontrer qu'il ne s'agit pas d'un cas isolé.
Le cas de cet enfant, qui n'a pas encore fait l'objet d'une publication dans une revue scientifique à comité de lecture mais seulement d'une communication orale, rappelle celui de Timothy Brown. Il a été baptisé le "patient de Berlin", car c'est dans la capitale allemande que cet américain séropositif pour le VIH, a été traité pour une leucémie par une greffe de moelle. Si un tel traitement est des plus classiques, les médecins berlinois ont eu l'idée originale de choisir un donneur de moelle sanguine présentant des caractéristiques génétiques faisant qu'il maîtrise spontanément, sans traitement antirétroviral, son infection par le VIH. Directeur général de l'Agence nationale de recherche sur le sida, le professeur Jean-François Delfraissy a rapproché le cas de l'enfant américain, le premier du genre, de celui d'une douzaine de patients adultes vivant avec le VIH suivis en France et chez qui l'infection demeure parfaitement contrôlée sans traitement.
Pour sa part, la professeure Françoise Barré-Sinoussi, co-lauréate du prix Nobelde médecine pour la découverte et l'identification du VIH s'est réjouie de ce pas en avant : "Nous avons à présent des preuves suggérant que traiter l'infection par le VIH serait possible. Nous devons stimuler le financement de recherches pour les traitements." Néanmoins, il reste à confirmer qu'un traitement intensif très précoce, durant un an et demi ou deux, serait susceptible de déclencher un contrôle de l'infection par le VIH même après l'arrêt des médicaments.
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De plus, la question est d'ores et déjà posée de savoir comment exporter à l'avenircette nouvelle approche dans les pays pauvres, là où vivent la plupart des 3,3 millions d'enfants infectés. Seulement 28 % d'entre eux bénéficient à l'heure actuelle de traitements anti-VIH et, même si ce nombre diminue nettement, on dénombrait en 2011 plus de 330 000 nouvelles infections chez des enfants. Outre leur procurer des traitements il faut commencer par atteindre les femmes enceintes pour mettre en œuvre une prophylaxie de la transmission. En 2011, dans les pays à revenu faible ou intermédiaire, environ 1,5 million de femmes vivant avec le VIH étaient enceintes mais seulement 57 % ont reçu un traitement pour prévenir la transmission du virus à leur enfant.
Paul Benkimoun
Un enfant guéri du sida aux États-Unis
Un enfant contaminé à la naissance par le virus du sida a été guéri à l'aide d'une trithérapie antirétrovirale précoce, ont annoncé dimanche des chercheurs américains. Une première qui pourrait changer la pratique médicale.
Guérir du sida entre désormais dans l’ordre du possible. Un jeune enfant contaminé à la naissance par le virus du sida (VIH) par sa mère séropositive a été guéri à l’aide d’une trithérapie antirétrovirale précoce, ont annoncé dimanche des chercheurs américains lors d’une conférence à Atlanta, aux États-Unis.
Il s’agit du premier cas de guérison fonctionnelle chez un nouveau-né, un cas déjà très rare chez l’adulte. Ainsi, à ce jour, la seule guérison complète officielle du sida est celle de Timothy Ray Brown, un Américain qui a été soigné en 2007 grâce à une greffe de moelle osseuse issue d’un donneur porteur d’une mutation génétique résistante au VIH.
Traité alors qu'il avait moins de deux jours
Originaire du Mississipi, le nourrisson "guéri" aux États-Unis a reçu des antirétroviraux moins de 30 heures après sa naissance, soit beaucoup plus tôt que ce qui se fait habituellement : les examens en laboratoire n’avaient même pas encore confirmé sa contamination.
Selon les chercheurs, c'est ce traitement précoce qui a permis sa guérison "fonctionnelle". Il aurait bloqué la formation de "réservoirs" viraux difficiles à traiter.
"Faire une thérapie antirétrovirale très tôt chez les nouveau-nés pourrait permettre d'obtenir une très longue rémission sans antirétroviraux en empêchant la formation de ces réservoirs viraux cachés", souligne le Dr Deborah Persaud, une virologue du Centre des enfants de l’hôpital de Baltimore, principal auteur de cette étude clinique.
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Un virus encore présent mais extrêmement faible
L'enfant a été traité régulièrement jusqu’à ses 18 mois. Il a ensuite disparu pendant 10 mois pendant lesquels il n’a pas été soigné. Lorsque ses parents l'ont ramené, les médecins se sont rendus compte que la présence du virus avait diminué.
Le virus n'a pas été complètement éradiqué mais sa présence est tellement faible que le système immunitaire de l'organisme peut le contrôler sans traitement antirétroviral, ont expliqué les chercheurs. Il n'apparaît par ailleurs plus dans les tests sanguins. Seules des traces ont été détectées par des analyses génétiques, mais elles pas suffisantes pour sa réplication.
Un cas qui pourrait changer les pratiques
Le cas de ce jeune enfant pourrait changer la pratique médicale actuelle en mettant en lumière le potentiel d'un traitement antirétroviral très tôt après la naissance.
Mais, soulignent les chercheurs, le premier objectif est la prévention pour empêcher la transmission de la mère à l'enfant. Les traitements antirétroviraux des femmes enceintes permettent actuellement d'éviter de transmettre le virus à l'enfant dans 98 % des cas, précisent-ils.
Quelques 300 000 enfants naissent séropositifs chaque année dans le monde, pour la plupart dans les pays pauvres où seulement 60 % des femmes enceintes infectées avec le VIH bénéficient d'un traitement.
Avec dépêches
Source: http://www.lemonde.fr/sante/article/2013/03/05/comment-un-enfant-a-ete-fonctionnellement- gueri-du-virus-du-sida_1843264_1651302.html
RFI
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Dr. Deborah Persaud, virologue au Centre pédiatrique Johns Hopkins de Baltimore, Maryland, auteure de l'étude sur le premier cas de guérison «fonctionnelle» du sida.
REUTERS/Johns Hopkins Children's Center
Par Claire Arsenault Pour la première fois une enfant née avec le virus du sida est aujourd’hui considérée comme guérie. L’annonce en a été faite lors de la 20e conférence annuelle sur les rétrovirus réunie du 3 au 6 mars 2013 à Atlanta, aux Etats-Unis. Cette guérison représente un nouvel espoir parce qu’elle rapproche un peu plus la perspective de parvenir à vaincre cette maladie qui touche 34 millions de personnes dans le monde, dont 24 en Afrique subsaharienne.
L’enfant, une fille dont ni le nom ni le prénom ne sont connus, est née fin 2010 dans le Mississipi. Dès sa naissance elle est contaminée par le virus du sida (VIH) transmis par sa mère séropositive qui ignorait être infectée. Aujourd’hui, l’enfant est apparemment guérie. Les médecins ont constaté que le virus n’avait pas complètement disparu mais sa présence est tellement réduite que le système immunitaire de l’enfant parvient à le contrôler sans qu’il soit nécessaire de lui donner un traitement antirétroviral. C'est ce que les médecins appellent une guérison « fonctionnelle ».
Traitement exceptionnellement précoce
Le cas de cette petite fille a été le clou de la 20e conférence annuelle sur les rétrovirus et les infections opportunistes qui se tient du 3 au 6 mars à Atlanta aux Etats-Unis. Même s’il faut évidemment rester très prudent et attendre de voir si cette « guérison » inédite est reproductible, elle n’en représente pas moins un espoir réel.
Un seul autre cas de guérison complète officielle existe, il concerne Timothy Brown dit le patient de Berlin, un homme séropositif qui a subi en 2007 une greffe de moelle osseuse pour traiter une leucémie. Or, il se trouve que cette moelle était porteuse d’une mutation génétique rare bloquant
34 l’entrée du virus dans les cellules. Cet exemple bien particulier est unique jusqu’à ce jour et risque bien de le rester encore longtemps.
Le traitement mis en place sur l’enfant américain, moins de 30 heures après sa naissance et avant même de savoir si elle était infectée, a consisté en une trithérapie. Les chercheurs estiment que la précocité inhabituelle du traitement explique probablement sa guérison « fonctionnelle » parce qu'elle a permis de bloquer la formation de réservoirs de virus difficiles à traiter. Ce sont ces cellules « dormantes » qui, chez la plupart des personnes séropositives, font remonter l’infection dans les semaines qui suivent une interruption des antirétroviraux.
Dans le monde, 300 000 bébés concernés
La pédiatre Hannah Gay de l’hôpital universitaire de Jackson (Mississipi) qui a reçu la petite fille dans les heures suivant sa naissance, a constaté sous traitement antirétroviral, une diminution progressive de la charge virale jusqu’à ce qu’au 29e jour, le virus devienne indétectable. L’enfant a ainsi poursuivi son traitement jusqu’à ses 18 mois, âge auquel les médecins perdent sa trace durant dix mois. Aucun traitement antirétroviral ne lui est administré durant cette période.
Quand la petite fille revient à l’hôpital, les médecins font aussitôt des tests pour voir où en est l’enfant. Et là, ils constatent que la présence du VIH est indétectable, seules des traces sont repérées grâce à des analyses génétiques mais qui sont insuffisantes pour se répliquer. Un tel résultat après des mois sans traitement est rarissime et le cas de cette enfant, guérie selon toute apparence, pourrait bien changer la pratique médicale actuelle. Au vu de ce résultat, la virologue Deborah Persaud, principale auteure de l'étude clinique sur ce cas, estime qu'il serait intéressant d'instaurer un traitement antirétroviral beaucoup plus tôt qu'on ne le fait actuellement pour les nouveau-nés à haut risque. « Cela permettrait, souligne-t-elle, d'obtenir une très longue rémission sans antirétroviraux ».
Cela dit, dans tous les cas où cela est possible, le mieux est de traiter par antirétroviraux les femmes enceintes séropositives. Quand ce traitement est mis en œuvre il permet dans 98% des cas d’empêcher la transmission du virus de la mère à l’enfant. Mais dans les pays pauvres seules 60% des futures mamans reçoivent des antirétroviraux et ainsi, chaque année, quelque 300 000 enfants naissent infectés dans le monde. C’est pour ceux-là notamment que le traitement dont a bénéficié précocement la petite Américaine pourrait s’avérer salvateur.
TAGS: ETATS-UNIS - SANTÉ ET MÉDECINE - SIDA
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Source: http://www.rfi.fr/ameriques/20130304-contamination-naissance-fille-bebe-guerie-sida- antiretroviral-virus-vih
Liberation
Le premier cas de guérison apparente d’un jeune enfant contaminé à la naissance avec le virus du sida (VIH) transmis par sa mère séropositive non traitée, annoncé dimanche aux Etats-Unis, conforte l’espoir de pouvoir vaincre cette infection dévastatrice.
Le virus n’a pas été complètement éradiqué mais sa présence est tellement faible que le système immunitaire de l’organisme peut le contrôler sans traitement antirétroviral, ont expliqué les chercheurs qui ont présenté ce cas à la 20e conférence annuelle sur les rétrovirus et les infections opportunistes (CROI) réunie ce week-end à Atlanta (Géorgie).
La seule guérison complète officielle reconnue au monde est celle de l’Américain Timothy Brown, dit le patient de Berlin. Il a été déclaré guéri après une greffe de moelle osseuse d’un donneur présentant une mutation génétique rare empêchant le virus de pénétrer dans les cellules. Cette greffe visait à traiter une leucémie.
Dans le cas de l’enfant pouvant désormais contrôler sans traitement son infection, il avait reçu des antirétroviraux moins de 30 heures après sa naissance, soit beaucoup plus tôt que ce qui est normalement fait pour les nouveaux-nés à haut risque d'être contaminés. Ce traitement précoce explique probablement sa guérison «fonctionnelle» en bloquant la formation de réservoirs viraux difficiles à traiter, selon ces chercheurs.
Ces cellules contaminées «dormantes» relancent l’infection chez la plupart des personnes séropositives dans les quelques semaines après l’arrêt des antirétroviraux. «Faire une thérapie antirétrovirale chez les nouveau-nés très tôt pourrait permettre d’obtenir une très longue rémission sans antirétroviraux en empêchant la formation de ces réservoirs viraux cachés», souligne le Dr Deborah Persaud, une virologue du Centre des enfants de la faculté du centre hospitalier universitaire Johns Hopkins à Baltimore (Maryland, est), principal auteur de cette étude clinique. C’est ce qui s’est apparemment passé avec cet enfant, estime cette chercheuse.
Les tests avaient montré une diminution progressive de la présence virale dans le sang du nouveau- né jusqu'à ce que le virus soit indétectable 29 jours après la naissance. L’enfant a été traité avec des antirétroviraux jusqu'à 18 mois, âge à partir duquel les médecins ont perdu sa trace pendant dix mois. Pendant cette période il n’a pas eu de traitement antirétroviral.
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Aucun des tests sanguins effectués ensuite n’a détecté la présence du VIH (virus de l’immunodéfience humaine). Seules des traces du virus ont été détectées par des analyses génétiques mais pas suffisantes pour sa réplication.
La suppression de la charge virale du VIH sans traitement est excessivement rare, étant observée dans moins de O,5% des adultes infectés, appelé «contrôleurs», dont le système immunitaire empêche la réplication du virus et le rend cliniquement indétectable, précisent ces virologues. Une étude présentée en juillet à la conférence internationale sur le sida à Washington avait indiqué que douze patients en France de la«cohorte dite de Visconti» infectés avec le VIH et mis peu après leur infection (8 à 10 semaines) sous antirétroviraux pendant près de trois ans, continuaient à contrôler leur infection six ans après sans traitement.
Selon les virologues le cas du jeune enfant apparemment guéri pourrait changer la pratique médicale actuelle en mettant en lumière le potentiel d’un traitement antirétroviral très tôt après la naissance pour ces nouveau-nés à haut risque. Mais, soulignent ces chercheurs, le premier objectif est la prévention pour empêcher la transmission de la mère à l’enfant.
Les traitements antirétroviraux des femmes enceintes permettent actuellement d'éviter de transmettre le virus à l’enfant dans 98% des cas, précisent-ils. Elle pourrait bénéficier aux quelques 300 000 enfants nés séropositifs chaque année dans le monde pour la plupart dans les pays pauvres où seulement 60% des femmes enceintes infectées avec le VIH bénéficient d’un traitement anti- rétroviral.
La recherche a été financée par les Instituts nationaux de la santé et l’American Foundation for AIDS Research.
Source: http://www.liberation.fr/sciences/2013/03/04/sida-la-guerison-fonctionnelle-d-un-jeune-enfant- relance-l-espoir_886065
ABC
Adult HIV Patients 'Functionally Cured' Before Mississippi Baby -- What These 'Cures' Mean
By SYDNEY LUPKIN (@slupkin) March 16, 2013
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On the heels of the supposed first "functional cure" for HIV in a baby born in Mississippi, French researchers reported Friday that they'd studied 14 adult patients who'd experienced a similar remission from the virus. The patients in the French study had been off HIV medications for up to 10 years.
The French researchers followed patients who'd undergone treatment with antiretroviral drugs soon after they'd become infected with HIV. They'd stayed on the medications for several years but then stopped taking the antiretrovirals. That was "fashionable at the time," said Christine Rouzioux, a professor at Necker Hospital and University of Paris Descartes. They are all now in what Rouzioux calls "HIV remission," because the virus has not worsened and they have not shown symptoms for years.
"I know that the U.S. term is 'functional cure,'" Rouzioux told ABCNews.com. "In France, we speak about 'remission.' … The patient controls the virus, but they still have the virus."
RELATED: Experts Question So-Called HIV 'Cure' The study, which was published Friday in the journal PLOS Pathogens, may show that the baby was not the first documented case of someone "functionally cured" of HIV as researchers announced earlier this month.
Rouzioux and PLOS representatives told ABCNews.com that they did not rush their study into publication when the case of the Mississippi baby was announced.
Dr. Deborah Persaud, who works at Johns Hopkins Children's Center and studied the Mississippi baby, said there were similarities between the 14 French patients and the baby, but the baby had even lower HIV levels than the French patients.
While Rouzioux and Asier Sáez-Cirión, a senior HIV researcher at the Pasteur Institute in Paris, reported about 100 copies of HIV DNA or RNA per 1 million cells in their patients, Persaud said she found less than five copies of HIV DNA or RNA per 1 million cells in the Mississippi baby.
"I'm not sure anybody knows what that means," said Dr. Mark Kline, a pediatric HIV and AIDS specialist at Baylor College of Medicine in Houston. "I don't know that someone with five is necessarily going to be better off in the long term than someone with 100."
RELATED: Hydeia Broadbent, Born With HIV, Reacts to 'Cure' Kline said he, too, has had patients who were technically HIV-positive but have had no need for antiretroviral medication. He has also heard of patients who started antiretroviral therapy and could stop without experiencing worsening symptoms.
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"This phenomenon that they're describing has been appreciated and known," Kline said. "I think there's a good rational for saying if you can identify these people and do treatment earlier, you can decrease the viral burden and decrease the reservoirs of infected cells in the body and probably alter the long-term course."
But it can take anywhere from a few weeks to a few years for a person to show HIV symptoms from the time that person was infected. As such, early treatment isn't always an option, Kline said.
Rouzioux's patients all experienced symptoms very early, which is why they were able to get swift antiretroviral treatment, she said. Rouzioux and her colleagues followed their patients for about 11 years, she said.
Although these types of patients have been written about before, Kline said this particular study was important because it identified which patients had a genetic predisposition that allowed them to naturally keep HIV at bay and which did not, and therefore went into remission because of treatment.
Source: http://abcnews.go.com/Health/french-hiv-study-means-hiv-babys-cure/story?id=18741318#.UcRF- _lQGSo CNN
Researchers: Toddler cured of HIV By Saundra Young, CNN
March 4, 2013 -- Updated 2154 GMT (0554 HKT)
(CNN) -- It's a potential game changer in the fight against HIV, and doctors say it happened almost by accident. A baby with the virus that causes AIDS was given high doses of three antiretroviral drugs within 30 hours of her birth. Doctors knew the mother was HIV positive and administered the drugs in hopes of controlling the virus.
Two years later, there is no evidence of HIV in the child's blood.
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The Mississippi girl is the first child to be "functionally cured" of HIV, researchers announced Sunday. They said they believe early intervention with the antiretroviral drugs was key to the outcome.
A "functional cure" is when the presence of the virus is so small, lifelong treatment is not necessary and standard clinical tests cannot detect the virus in the blood.
Timeline: AIDS moments to remember
The finding was announced at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta.
The unidentified girl was born HIV positive to a mother who received no prenatal care and was not diagnosed as HIV positive herself until just before delivery.
"We didn't have the opportunity to treat the mom during the pregnancy as we would like to be able do to prevent transmission to the baby," said Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi Medical Center.
Gay told CNN the timing of intervention -- before the baby's HIV diagnosis -- may deserve "more emphasis than the particular drugs or number of drugs used."
"We are hoping that future studies will show that very early institution of effective therapy will result in this same outcome consistently," she said on the eve of the Atlanta conference. High-risk exposure
Dr. Katherine Luzuriaga, an immunologist at the University of Massachusetts who worked closely with Gay, called the developments fascinating, including the fact that the toddler was found to have no virus in her blood even after her mother stopped giving her treatment for eight to 10 months. "This is the very first case in which we've conclusively been able to document that the baby was infected and then after a period of treatment has been able to go off treatment without viral rebound," Luzuriaga told CNN.
Once it was determined the Mississippi mother was HIV positive, Gay immediately began giving the infant antiretroviral drugs upon the baby's delivery in an attempt to control HIV infection. Read more: Why youths aren't getting tested for HIV
"We started therapy as early as possible, which in this case was about 30 hours of age," the physician said. "And because it was a high-risk exposure, I decided to use three drugs rather than one."
Within a couple of days, Gay confirmed the child was HIV positive. She said the baby had probably been infected in the womb. The child remained on antiretroviral drugs for about 15 months. Her mother then stopped administering the drug for some reason, and care was resumed after health officials intervened, Gay said.
Researchers have long known that treating HIV-positive mothers early on is important, because they pass antibodies on to their babies.
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"One hundred percent of (HIV-positive) moms will pass those antibodies, but in the absence of treatment, only 30% of moms will transmit the actual virus," Luzuriaga told CNN. HIV-positive mothers given appropriate treatment pass the virus on in less than 2% of cases, Luzuriaga said.
"So all babies are born antibody positive, but only a fraction of babies born to HIV-positive women will actually get the virus, and that fraction depends on whether the mom and baby are getting antiviral prophylaxis (preventative treatment) or not," Luzuriaga said.
Newborns are considered high-risk if their mothers' HIV infections are not under control or if they are found to be HIV positive when they're close to delivering.
Moving quickly to suppress the virus Usually, these infants would get antiviral drugs at preventative doses for six weeks to prevent infection, then start therapy if HIV is diagnosed.
Investigators said the Mississippi case may change that practice because it highlights the potential for cure with early standard antiretroviral therapy, or ART.
ART is a combination of at least three drugs used to suppress the virus and stop the progression of the disease.
But they do not kill the virus. Tests showed the virus in the Mississippi baby's blood continued to decrease and reached undetectable levels within 29 days of the initial treatment.
Dr. Deborah Persaud, a virologist with Johns Hopkins Children's Center, was lead author on the report presented at the conference.
The early treatment likely led to the infant's cure, she said.
'Like pulling teeth' to get doctors to test for HIV
"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," Persaud said.
Persaud and Luzuriaga are part of a group of researchers working to explore and document possible pediatric HIV cure cases. The group was funded by a grant from amfAR, the Foundation for AIDS Research, and the National Institutes of Health. Dr. Rowena Johnston, amfAR vice president and director of research, said it is "imperative that we learn more about a newborn's immune system, how it differs from an adults and what factors made it possible for the child to be cured."
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said he is enthusiastic about the findings.
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"The best way to either eliminate the virus or allow the immune system to suppress residual virus is to treat someone as early as possible after infection so as not to allow a substantial reservoir of the virus to take hold," Fauci told CNN.
"At the same time, you prevent the immune system from being severely damaged by the continual replication of (the) virus for an extended period of time," he said. "The situation with a child born of an infected mother where most of the infections are transmitted to the newborn at or around the time of delivery provides an excellent opportunity to cure an infected baby, and this approach deserves further study."
'Berlin patient'
Researchers say the only other documented case of an HIV cure is that of Timothy Brown, known as the "Berlin patient." In 2007, Brown, an HIV-positive American living in Germany, was battling both leukemia and HIV when he underwent a bone marrow transplant that cured not only his cancer but his HIV.
In an interview last year, Brown told Dr. Sanjay Gupta, CNN's chief medical correspondent, he was still HIV-free.
"I've been tested everywhere possible," said Brown, who now lives in San Francisco. "My blood's been tested by many, many agencies. I've had two colonoscopies to test to see if they could find HIV in my colon, and they haven't been able to find any."
But Brown's case is rare.
And the procedure, which is extremely dangerous, won't work in most patients because the bone marrow he received had a special genetic mutation that made the stem cells in it naturally resistant to the virus.
Researchers tell CNN only 1% of Caucasians -- mostly Northern Europeans -- and no African- Americans or Asians have this particular mutation.
In June, five years after he was "cured," reports surfaced that "traces" of the virus had been found in Brown's blood.
Even then, some HIV experts said that doesn't matter, that he's been cured. In fact, many AIDS experts said they believe Brown has experienced what's called a "sterilizing" cure, meaning the virus has been eliminated from the body entirely.
Routine clinical testing on the Mississippi toddler continues, Gay said. So far, there is no evidence of the virus.
"On the ultra-sensitive testing, we are occasionally getting signals so we cannot say with certainty that this child is absolutely clear of HIV, but we will continue to follow up with the baby," Luzuriaga said.
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"We have formed a hypothesis and that is already driving the design of new studies and clinical trials that will help us to answer the question of whether by coming in very early we will be able to treat children for a while and then remove them from therapy."
Source: http://edition.cnn.com/2013/03/03/health/hiv-toddler-cured
NBC
A baby now free of HIV has doctors talking about 'cure'
Maggie Fox, Senior WriterNBC News
March 3, 2013 at 4:33 PM ET
A baby born infected with the AIDS virus who got immediate treatment now has no detectable virus in her blood – not quite a cure, but so close to one that it has doctors talking about the possibility.
Her case, presented to a meeting of AIDS researchers that started Sunday, will prompt questions about how early babies should be treated – and further illustrates the possibility that immediate treatment with HIV drugs might stop infection in its tracks and could even have an impact on the AIDS pandemic.
“What we have identified is what we think is the first well-documented case of a functional cure in a neonatal child,” Dr. Deborah Persaud of the Johns Hopkins Children’s Center, the virologist who led the study, told NBC News.
A functional cure, says Persaud, means the virus isn’t entirely gone, but it’s not doing any damage, either. Doctors think it was because they began therapy for the baby within 48 hours of being infected, she told a conference in Atlanta of HIV specialists.
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The child, who lives in rural Mississippi, is now 2 1/2 and healthy. She was, like so many, born to a mother who didn’t know until right before she gave birth that she had the human immunodeficiency virus (HIV) that causes AIDS. Mom and baby both got a standard dose of HIV drugs right away – something that has been shown to prevent what’s known as mother-to-child transmission of the virus in newborns.
The baby was a little premature and so stayed in the hospital. Within 30 hours of birth she was re- tested and had clear evidence of HIV infection. Unusually, she then got a cocktail of three drugs at a dose normally reserved for more advanced cases. It worked really well – pushing her virus down to what’s called undetectable levels. This is what doctors want with HIV, because if the virus can’t be found in the blood, then it can’t be spreading and damaging the immune system. HIV doesn’t kill directly – it kills patients by damaging their immune systems so bad they can’t fight off other infections.
The baby and her mom, who doctors aren't naming, got regular care and treatment by Dr. Hannah Gay at University of Mississippi Medical Center until she was 15 months old. Then, like so many children, she disappeared off the doctors’ radar screens. The mother brought her back briefly at 18 months but disappeared again but she missed at least eight months worth of drugs. When Gay caught up to her again, the baby was still well, despite having received no treatment. More remarkably, tests showed the virus had not come back.
“My first thought was, ‘oh my goodness. We have been treating an uninfected child,” Gay told NBC News. "But I checked the records which confirmed she was, in fact, infected.”
Dr. Katherine Luzuriaga of the University of Massachusetts Medical School, who also worked on the study, piled on with a battery of tests. Even a sensitive test called PCR, which can help find tiny bits of genetic material from a virus, couldn’t detect any evidence of HIV. This went far beyond the usual definition of "undetectable" in treating the AIDS virus - there really was no evidence the virus was there.
“What we did then was to get a group of collaborating laboratories together to apply ultra-sensitive testing and say ‘can we detect any evidence of virus’,” Luzuriaga says. They did eventually find pieces of genetic material from the virus.
But Persaud has been unable to find any evidence of virus that can invade cells or replicate. “So the baby has remained off treatment. We are just watching and we will follow the baby and do additional testing.”
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It’s not a true cure – what doctors call a “sterilizing” cure. There is still virus in the toddler’s body. But it’s not is a form that seems to be doing any damage. It doesn’t seem to be able to spread from one cell to another and it doesn’t seem to be damaging the child’s immune system.
About 34 million people globally are infected with HIV, the virus that causes AIDS; 25 million have died from it. While there’s no vaccine, cocktails of powerful antiviral drugs called antiretroviral therapy (ART) can keep the virus suppressed and keep patients healthy. No matter how long patients take ART, however, they are never cured. The virus lurks in the body and comes back if the drugs are stopped. Scientists want to flush out these so-called reservoirs and find a way to kill the virus for good.
“This has major implications for how we begin to think about treating children,” Persaud says. “Perhaps we can spare them a lifetime of treatment.”
But she adds, it’s one case. “We need to figure out if this can be reproduced or replicated in other infants.”
Babies born to HIV-positive women are different from other HIV patients. Doctors know the precise moment that they are infected and can treat them right away. But usually they treat them with low doses of drugs for about six weeks and then wait to see if infection has really developed before they treat them again. If done right, this treatment around birth can prevent 95 percent of infections.
Up to now, only one person has been documented with a cure – the so-called Berlin patient, Timothy Brown, who was treated for leukemia with a bone marrow transplant that happened to come from a donor with a genetic mutation that makes immune cells resist HIV infection. The transplant replaced his own infected cells with healthy, AIDS-resistant cells. He is remains free of the virus more than five years later.
Dr. Dan Kuritzkes of Brigham and Women's Hospital and Harvard Medical School is treating two HIV other patients who, like Brown, got bone marrow transplants for leukemia or lymphoma. His team wants to see if they, too, can be cured. “They are doing fine,” he says – but continue taking HIV drugs to be safe.
But a third patient he was treating suffered a relapse of lymphoma and died. “It sort of underscores what these patients have been through,” he said. No one thinks a bone marrow transplant represents a real-life treatment for anyone with HIV, because it’s so hard on the body.
Kuritzkes said AIDS experts have wondered whether very early treatment of newborns could be in fact treating their infection rather than preventing it.
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“It’s exciting because there are undoubtedly other children in this situation,” he said. His team is taking part in several studies looking at whether it is possible to eradicate the reservoirs of virus in adults that should have results within a year.
There are also patients called “elite controllers” who seem to stay well and suppress the virus without the need for drugs.
Luzuriaga says this toddler is not an elite controller. “You can detect HIV DNA in their cells. And you can culture virus from them,” she said. “We just think that this baby has much tighter control, much tighter control. This baby hasn’t rebounded off therapy.”
“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,” says Persaud.
It might be that quick treatment stopped the virus from hiding out in the baby’s body, and allowed the drugs to do their work and stop the spread of the virus.
Ami Schmitz contributed to this story.
Source: http://www.nbcnews.com/health/baby-now-free-hiv-has-doctors-talking-about-cure-1C8662659
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