By: Sony Salzman
Many HIV researchers remember with disappointment the highly publicized story of the Mississippi baby, a newborn seemingly cured of HIV, who after being treated with antiretroviral therapy (ART) and subsequently discontinued, remained in apparent remission until after 2.5 years when he experienced a rebound in viral load.
Now, research presented at the 2020 Conference on Retroviruses and Opportunistic Infections (CROI) offers new hope.
The poster, titled "Sustained Remission in a 4-Year-Old HIV-Infected Child Treated in the First Year of Life," describes a case study that surpasses the record set by the Mississippi baby, with this child remaining clinically well for at least three years without treatment.
According to the Department of Health and Human Services guidelines published in December 2019, newborn babies in these circumstances should receive ART with three drugs, as it has a double benefit since it can potentially act as prophylaxis for those who never seroconvert.
The case study was led by Gloria P. Heresi, MD, a pediatric infectious disease specialist at the University of Texas at Houston.
With the advent of ART, the perinatal HIV transmission rate in the United States has fallen to less than 2%. However, some families still go undetected in the healthcare system, and situations like these motivate physicians to do everything possible to prevent HIV infection among newborns of mothers without prenatal care.
This case study involves a newborn baby whose mother had been diagnosed with HIV six years prior and had never received treatment. At the time of delivery, the mother had a viral load of 14,400 copies of HIV RNA/ml and a CD4 count of 27%. Doctors started antiretroviral therapy (ART) 33 hours after birth. Unfortunately, blood samples taken on the first and second days of the child's life to test for HIV were unsuccessful due to technical difficulties, according to the case study. Two weeks after birth, a test did detect HIV DNA in the child's blood. Researchers then re-examined dried blood samples that had been preserved from the first unsuccessful attempt, and this blood sample was also positive. After one year of ART, the mother discontinued her child's treatment. Remarkably, the child's HIV antibodies became negative a few months later and remained so. For the next three years, in addition to routine clinical trials, doctors monitored the child using PCR, maintaining an undetectable viral load.
Heresi and his colleagues will continue to monitor the child for signs of viral rebound, and are investigating exactly how and why this child has been able to maintain viral control.
Perhaps in recognition of the false hope presented by the Mississippi baby case, Heresi and colleagues do not claim that this new baby has been cured of HIV. However, this case study adds further evidence to support the concept of aggressive ART immediately after birth among infants born to HIV-positive mothers who have not received prenatal care and are not on HIV treatment.
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