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First Child Cured of HIV

Flickr Creative Commons/raham

The first baby has been cured of HIV, researchers announced Sunday. The case was publicly unveiled at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta.

The infant, who is now two and a half years old, was born to a “high-risk” mother in Mississippi. The mother was not diagnosed with HIV (human immunodeficiency virus) until delivery, and therefore did not receive the typical prenatal treatment for the disease that could have prevented transmission to the baby.

The pediatrician, Dr. Hannah Gay of the University of Mississippi, began treating the baby with a stronger-than-usual cocktail of drugs within hours of birth.

Around 18 months, the child’s mother stopped treatment and follow-up visits for the baby. But five months later, the child returned to care and was found to have an “undetectable viral load” — the baby was no longer considered HIV-positive.

When HIV is diagnosed before or during pregnancy, prenatal transmission can be reduced to less than 1 percent with proper care. Since the mid-1990s, the number of infants born with HIV has dropped by 90 percent.

The only other documented case of an HIV cure to date remains that of Timothy Brown, the so-called “Berlin patient.” In 2006, while on treatment for HIV, Brown was diagnosed with leukemia. He was treated with a stem cell transplant from someone who was born with the genetic mutation that causes immunity to HIV infection. After the transplant, Brown appeared to be completely free of the virus. While test results have caused some skepticism in recent months about whether trace amounts remain in his tissue, Brown says any remnants of the virus still in his body are dead and can’t replicate.

Regardless, Brown’s treatment would be too complex, high-risk and expensive to cure the millions living with HIV/AIDS worldwide. That’s why the researchers involved say this new case holds so much promise: the child in Mississippi was cured through a relatively inexpensive course of antiretroviral therapy.

Confirmation of the baby’s HIV status came from Dr. Katherine Luzuriaga of the University of Massachusetts Medical School and Dr. Deborah Persaud of Johns Hopkins University. They established a research collaboratory, funded by amfAR, The Foundation for AIDS Research, that included Dr. Stephen Spector and Dr. Doug Richman at the University of California, San Diego; Dr. Frank Maldarelli at the National Cancer Institute; and Dr. Tae-Wook Chun at the National Institute of Allergy and Infectious Diseases.

“This case is a startling reminder that a cure for HIV could come in ways we never anticipated,” amfAR’s CEO Kevin Robert Frost said in a statement. “We hope this is the first of many children cured of HIV in the months and years to come.”

We spoke to Dr. Luzuriaga about the team’s research on Friday afternoon.

NEWSHOUR: Thank you so much for joining us, Dr. Luzuriaga.

DR. KATHERINE LUZURIAGA: Thank you. I’m glad to be here.

NEWSHOUR: First of all, how big is this news? Would you classify it as a major breakthrough in treating AIDS?

DR. LUZURIAGA: Well, it’s one case. But often a single case can tell you a lot, mostly because it stimulates intense interest, you develop hypotheses, conduct laboratory studies or further clinical trials to test those hypotheses. And that’s where the real breakthroughs and confirmation come in. So I think this is an exciting case.

In that way, it’s somewhat similar to the “Berlin patient,” which was the first case of a functional cure in an adult. What it did was to provide some proof of concept that this may be achievable. So one case is interesting but clearly more work needs to be done to really understand why this happened and to better understand whether and how this can be replicated in other children.

NEWSHOUR: Let’s dive a little deeper into the specifics of this case. What happened here?

DR. LUZURIAGA: This baby was born to a very high-risk mother who was not diagnosed as HIV-infected until she presented in labor. So she had no prenatal care, which put the baby at risk for HIV infection. Customarily, if you’ve got a mom that’s HIV-positive, antiretroviral drugs during pregnancy are recommended and then you treat the baby for a period of time afterward to prevent mother-to-child transmission.

Because this baby was at risk, Dr. Gay decided to begin treatment very early and to treat the baby with three drugs. The baby had blood drawn at 30 hours and then was started on antiretrovirals without knowledge of what the baby’s status was. The tests turned up positive.

The baby remained on treatment for anywhere between 15 to 18 months. There was a little bit of uncertainty there because the baby did not engage in routine care for a time and then reappeared at 23 months. And when the baby reappeared at 23 months, Dr. Gay prepared to test the baby to get the baby back on treatment. And she was incredibly surprised when that first viral load came back negative. It’s almost unheard of. Babies need almost constant therapy. They suppress the virus when you put them on treatment, but if you take them off, the virus comes back. And in this case, it didn’t.

So then she repeated testing, thinking something was wrong with the lab test. And it was negative again. At that point in time, she called me because we’ve worked together as colleagues intermittently since the mid-1990s, caring for HIV-positive kids and doing clinical trials through the NIH-sponsored clinical trials group. When she told me about this, we thought this was quite unusual and so we assembled a team of individuals and went on to do some very specialized research to see exactly how much virus there was in the baby’s system and what form it was in. Using those very sensitive tests, we were able to detect occasionally very, very low levels of the viral nucleic acids.

One of the doctors developed a very sensitive culture technique to see whether she can actually grow virus from people’s cells. She tried to do that from the baby but she was unable to recover the virus. Then I did immunologic studies, and the kind of the immune repercussions that we usually see in HIV-positive individuals were not there. We retested the baby through 28 months, and the baby has continued to control the virus. In other words, we do not see the viral load coming back in the absence of treatment.

NEWSHOUR: But there are still low levels of the virus in the baby’s system?

DR. LUZURIAGA: Yes, but we’re not quite sure what it means. These are very low levels of virus that are around and we don’t know whether these are false positives or whether they truly constitute viral load but it’s just so low that it’s tough to detect.

NEWSHOUR: So what was done differently with this infant compared to other HIV-positive infants? Was the therapy stronger?

DR. LUZURIAGA: Well, I think it was the timing of initiation. This child received three medications to prevent transmission and those three medications were continued when the child was diagnosed as infected. As a result, this baby received treatment much earlier than has been customary in the past, which we think contributed to the outcome.

NEWSHOUR: Could this be something specific in this child’s genes that could have caused it to respond in this way?

DR. LUZURIAGA: Whenever something like this happens, we always say, ‘Is this the virus? Or is it the host?’ And studying those things can tell us a lot. For example, we know there are certain genetic types that are associated with individuals who control the virus better. You might have heard of individuals called “elite controllers,” people who are associated with particularly good T-cell responses that help control the infection. But we have looked at the baby’s [genetic] type, we’ve looked to see if the baby makes HIV-specific immune responses, and we have not detected any. The baby does not appear to have other genetic types that are associated with good control of infection.

NEWSHOUR: Do you foresee any specific implications for HIV treatment?

DR. LUZURIAGA: I think this is most relevant for babies who are born with HIV. We have pretty effective ways that can prevent mother-to-child transmission. And that is always our goal: to prevent babies from getting infected in the first place. Unfortunately, there are some children who still acquire infection, mostly because the mothers did not get prenatal care and were not identified as HIV-infected. So we need to redouble our efforts in that area.

But kids still get infected, and the guidelines recommend treatment during the first year of life. I think what this suggests to us is that if we treat earlier — even earlier — within the first several days to week of infection perhaps (though we don’t know what that window would be) that we may be able to markedly curtail the amount of virus and the extent of viral reservoirs that are set up in the body. By doing so, and by treating for a period of time, we may get to a point where we could allow children to safely discontinue therapy. That is the hypothesis that this particular case raises, and now we’re constructing the clinical trials to look exactly at that.

NEWSHOUR: Any things we can learn from this case for treating adult HIV cases?

DR. LUZURIAGA: I think there may be some. But children are different than adults. Their immune systems are different, so we’re not sure yet.

NEWSHOUR: Dr. Luzuriaga, thank you so much for being with us.

DR. LUZURIAGA: Thank you.

This conversation was lightly edited for clarity. Top photo coursesy of Flickr Creative Commons/raham. Photo of Dr. Luzuriaga courtesy of University of Massachusetts Medical School.

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