Disappointment has once again been shared between medics and scientists as, for the second time, the hopes of a cure for HIV have been dashed by the reappearance of the virus in a child that was thought to be cleared of infection. Just like the famous “Mississippi baby” that made headlines last fall, the child was given aggressive therapy shortly after being born to an HIV-positive mother. Encouraged by the former case, therapy was eventually stopped in the toddler and he was monitored closely. But the virus soon came bounding back in both children, demonstrating that early treatment is insufficient to completely rid the body of infection.
As reported in the Lancet, the baby was born back in 2009 in Milan to a woman with a history of intravenous drug use. She was unaware of her status at the time of labor, but rapid testing revealed that she was HIV-positive and had high levels of the virus in her body. Twelve hours after he was born, numerous different tests were performed to make sure that any signs of the virus were not missed, and unfortunately they found that he too was infected and also had a very high viral load (over 150,000 copies of the virus per milliliter of blood).
Doctors then immediately began aggressive therapy, starting off with two different drugs and then adding a third on day four. The baby responded well to the drugs and his viral load dropped to undetectable levels within just six months. For the next two and a half years, all tests for the virus remained negative. Because of the reported success of the Mississippi baby, the child’s doctors and mother agreed to stop the treatment.
Although the doctors couldn’t detect any signs of rebound within the first week, his immune system was showing telltale signs of infection, such as an increase in activated white blood cells. Just one week later, further tests revealed that his viral load had shot up to almost 37,000 copies per milliliter of blood. This meant that although the drugs were effectively controlling his infection, they had once again failed to clear the so-called viral reservoirs where the virus hides in certain populations of cells. This remains a major hurdle in HIV treatment and until this can be achieved, antiretroviral drugs cannot be curative.
While this case is disappointing, most doctors are in agreement that this aggressive early approach in infants born with HIV has merit. “I think we will find a functional cure. We just haven’t found it yet,” said Dr. Michael Horberg, director of HIV/AIDS for Kaiser Permanente. “That doesn’t mean the principles of a strategy of hitting hard for an extended period should not work.”