HIV Detected in Child Formerly Believed to Be 'Functionally Cured'

A story that captivated the medical community for the past few years has reportedly taken a bad turn, as a 4-year-old child who was previously believed to be cured of HIV is once again showing signs of the virus.

Known as the “Mississippi baby,” the child was born prematurely in 2010 to a mother who had contracted HIV, but had not taken antiretroviral therapy (ART) during her pregnancy and had not been diagnosed with the virus until the time of delivery. Just 30 hours after the baby was born, doctors began treating the virus with a liquid ART combination of zidovudine, lamivudine, and nevirapine.

Following discharge after only 2 weeks, the child’s treatment continued until the age of 18 months when, according to the National Institute of Health (NIH), “the child was lost to follow-up and no longer received treatment.” Five months later, blood samples from the baby showed “undetectable HIV levels” and “no HIV-specific antibodies.”

At the time, the child’s doctors led by Hannah Gay, MD, a pediatric HIV specialist at the University of Mississippi Medical Center, were encouraged that the virus was “functionally cured” after 2 years of treatment.

“Despite the fact that research has given us the tools to prevent mother-to-child transmission of HIV, many infants are unfortunately still born infected,” National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD, said at the time. “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.”

However, the baby’s doctors received some bad news during a recent follow-up appointment, when results of blood tests showed detectable levels of HIV, decreased levels of CD4+ and T-cells, and the presence of HIV antibodies. As a result, ART was again initiated, which “the child is tolerating … with no side effects and treatment is decreasing virus levels,” the NIH said.

During a press conference, Gay told Los Angeles Times reporters that the latest information is “extremely disappointing, both from the scientific standpoint that we had been very hopeful that this would lead to bigger and better things, but mainly for the sake of the child, who now is back on medicine and expected to stay on medicine for a very long time.”

In light of those developments, Fauci said there is much more work to be done to find a cure for HIV.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care, and the HIV/AIDS research community,” he said. “Scientifically, this development reminds us that we still have much more to learn about the intricacies of HIV infection and where the virus hides in the body. The NIH remains committed to moving forward with research on a cure for HIV Infection.”

While the relapse was unfortunate for the child, other healthcare professionals have expressed optimism at the length of remission without medication.

“The fact that this child was able to remain off ART for 2 years and maintain quiescent virus for that length of time is unprecedented,” Deborah Persaud, MD, Professor of Infectious Disease at the Johns Hopkins Children’s Center, said in the NIH statement, noting that, in most cases when treatment is stopped, levels of HIV return in weeks, rather than years.

Persaud and Katherine Luzuriaga, MD, Professor of Pediatrics and Molecular Medicine at the University of Massachusetts Medical School in Worcester, MA, provided the original lead analysis on the case. Although relapse was clearly not what the doctors anticipated, Fauci said the information they gathered could go a long way in helping not only the Mississippi baby, but also other HIV-positive individuals in the future. According to the New York Times, 2.3 million people were newly infected with HIV in 2012, including 260,000 infants infected at birth or immediately after.

“The case of the Mississippi child indicates that early ART in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection, but may have considerably limited its development and averted the need for ART over a considerable period,” Fauci said. “Now, we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged even further.”

Despite the setback, the Elizabeth Glaser Pediatric AIDS Foundation said in a press release that the case still provides hope for families of children infected with the virus.

“Although we had high hopes that the child would remain HIV-free, this case represents important research that still provides a tremendous learning opportunity about how rapid, early treatment affects the body’s response to HIV, especially in newborns, which eventually could lead to a cure,” said R.J. Simonds, MD, who serves as the foundation’s Vice President of Program Innovation and Policy.

“Efforts to take what we have learned from this case and apply it to future studies must stay high on the HIV research agenda,” Simonds added, pointing to the need for “increasing access to treatment for children who are currently living with HIV,” which he called “equally critical.”

According to the Los Angeles Times article, part of that work will involve conducting a clinical trial for HIV-infected babies to determine whether they can be taken off of ART once they show signs of remission. However, study co-chair Yvonne Bryson, Professor of Pediatrics and Chief of Pediatric Infectious Diseases at the David Geffen School of Medicine at UCLA and Mattel Children’s Hospital UCLA, said enrollment would be delayed “so that experts could review it for potential ethical issues.”

“I don’t think there are any issues,” Bryson told the Los Angeles Times. “In fact, I think this news really points to the need to do more critical research.”