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HIV rebound in young child is ‘another step’ in long process of AIDS research

July 11, 2014 at 6:12 PM EST
AIDS researchers announced a setback in the long search for a cure. Doctors believed that they had cured a baby girl by using aggressive and early treatment. But after years without requiring therapy, she tested positive for HIV during a follow-up visit. Jeffrey Brown talks to Dr. Anthony Fauci of the National Institute of Allergy and Infectious Disease, who has been involved with the case.
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JUDY WOODRUFF: There’s been a big disappointment in the hope to find a cure for AIDS. It involves a young child who was thought to have been cured of HIV as a baby.

Jeffrey Brown has the story.

JEFFREY BROWN: It was in March of last year that doctors thought they might have made a breakthrough in the goal of finding a cure for AIDS, treating a baby girl in Mississippi with early and unusually aggressive drug therapy.

The mother had HIV and had not been treated during pregnancy. But the girl was treated within 30 hours of her birth and was free of the virus for two years. Doctors allowed her to stay off therapy and, still, there were no signs of HIV returning.

But, yesterday, officials announced that the girl, now almost 4, had tested positive for HIV during a follow-up visit last week.

Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases joins me now.

And welcome back to you.

This is something that you and I talked about when the news came out last year. So, remind us first why this seemed so hopeful, how this early and aggressive treatment promised such a difference.

DR. ANTHONY FAUCI, National Institute of Allergy and Infectious Diseases: Well, it promised such a difference because what happened with this particular baby was an unusual situation, that the baby had been on therapy, this aggressive form that you correctly described, for about 18 months, but then was lost to follow-up.

And the mother discontinued the therapy because she just dropped out of the — out of the health care system, came back five months later, and when the physicians examined the baby, they found out that they couldn’t find the virus anywhere by the standard methods of looking for virus, no virus in the plasma and no virus in the cells in the blood.

So they decided that this possibly could have been a cure related to the fact that the baby was treated very early, as you mentioned, within 30 hours, and aggressively. As it turned out, they followed the baby very, very carefully, and over a period of 27 months without any therapy at all, there was no indication at all of any virus in the baby. There was no plasma viremia, as we say, namely virus in the blood.

And they couldn’t get any virus out of the cells. And then, on a routine visit — and this was most unusual that you would have 27 months off therapy — and, as you know, this was widely discussed throughout the world as a possible cure of a baby. And then last week, on a regular routine visit to the clinic, the baby was doing quite well.

They drew some blood and found that one of the lab tests was a little bit abnormal, so they looked at the level of virus, and they found, to their surprise and disappointment, that the virus had actually rebound. So, clearly, it was — the virus wasn’t eradicated.

JEFFREY BROWN: Well, you use that word disappointment.

You have been doing this a long time. Was it — is it surprising to you? How deflating is it this time later to find out what happened?

DR. ANTHONY FAUCI: Well, Jeff, I would describe it not as deflating. I’m disappointed, but not surprised. And that’s a very good question you ask.

This virus is extraordinarily uncanny, and we have been working with trying to figure out the complexities of this reservoir where the virus hides in the body for a very long period of time. I have been doing this now for over 25 years. And I’m never surprised at some of the things that this virus can do, namely be in the body.

Any assay that we do, we couldn’t find it, and then all of a sudden 27 months into no therapy at all, the baby rebounds. So I’m not surprised, but I am a little bit disappointed.

JEFFREY BROWN: Well, so in terms what happens next is and consequences, one thing that, in fact, you and I had talked about it when this first came out, was that there was going to be a trial based on this to look further.

DR. ANTHONY FAUCI: Right.

JEFFREY BROWN: What happens now to that trial? Does it go forward in some form?

DR. ANTHONY FAUCI: Well, OK.

Let’s first just for moment talk about the baby. The baby was put back on antiviral drugs and is doing extremely well. The virus is already starting to come back down. With regard to the study that you’re talking about, this is something that we’re going to look very carefully at, particularly in the design of the study, as well as the ethical considerations about situations of the informed consent, which will now have to be altered, because this study was predicated on the fact that this baby may have been cured.

Now, the fact that the baby went 27 months without requiring therapy is a good thing. So you’re going to have to change and maybe look at the design and make sure, above all things, that it’s an ethically sound study.

JEFFREY BROWN: So, go ahead with it, but, ethically, you have to tell the people, here’s the new situation?

DR. ANTHONY FAUCI: Right, exactly. And even before you go ahead with it, make sure that the design of it is compatible with something that’s ethical and something that we can learn — something that’s beneficial to the entire cohort of babies in the future.

JEFFREY BROWN: Just in our last minute, going back to this thought of how long you have been at this and we have been talking about this for many years, do we have a tendency to make the highs too high and the lows too low when you’re — because this is such a long search for a cure?

DR. ANTHONY FAUCI: I think some people do that, and it’s human nature and understandable.

As you remember, back then, Jeff, when we discussed this, I said, we better be careful not to call something a cure. This is a remission. How long the remission will last will depend upon whether it ultimately turns out to be a cure.

So I tend to be very circumspect and conservative in that. But you can understand when you’re dealing with a disease that’s serious like this, when you get good news, you like to essentially expand on good news. This is just another step in the long process of what we have to learn about this very devastating disease.

JEFFREY BROWN: All right, Dr. Anthony Fauci, thank you so much.

DR. ANTHONY FAUCI: You’re quite welcome.