'Mississippi Baby' Relapse Provides Clues about HIV

The case of the “Mississippi baby,” who was deemed HIV-free but relapsed 2 years after ceasing treatment, adds to evidence researchers can use to find an effective cure, experts at Johns Hopkins Medicine asserted.

The Mississippi baby, a toddler who acquired HIV through the mother, was touted for being essentially cured of HIV through early and rigorous antiretroviral treatment. However, after 27 months of being off of treatment, a blood test detected the virus had returned.

The researchers also cited previous viral rebounds 3 to 8 months after ceasing treatment amongst 2 HIV-1 adults who underwent a bone marrow transplant. In that case, both patients HIV-immune cells were killed when they underwent chemotherapy and experienced graft-versus-host disease, leaving transplanted uninfected cells.

On average, an HIV-positive individual stopping treatment will experience a relapse within a few weeks, a Johns Hopkins Medicine release pointed out.

Overall, HIV remission and ending treatment has been viewed as the optimal outcome combination. However, difficulty complying with a vigorous treatment regimen early on can mutate and make the virus resistant to drugs, the release also mentioned.

Though the outcome to these incidents has been described as “a blow to HIV-1 eradication efforts,” Robert Siliciano, MD, PhD, and Janet Siliciano, PhD, authors of the Science study, claimed these so-called failures have added to evidence highlighting memory CD4+ T cells’ role in HIV infection.

“Although disappointing, the late rebounds are of enormous scientific importance,” the researchers wrote. “They reaffirm the concept that HIV-1 can persist by establishing latent infection and point to this challenge as the major hurdle in achieving a cure for HIV-1 infection.”

Mostly inactive, memory T-cells are responsible for fighting foreign invaders that they have encountered before. Typically, the HIV virus attacks the cells early in the infection process, which makes HIV undetectable in the body. Viral replication begins when DNA alerts both memory T-cells and the HIV inside of it.

“These cases paint several clinical scenarios where a substantial reduction of viral reservoirs would allow some patients to come off treatment for prolonged yet uncertain periods of time,” Janet Siciliano said.

However, she also commented that pinpointing a potential relapse if difficult, which makes treatment reimplementation arduous as well.

“Clearly, neither approach managed to eradicate all latently infected cells, and what these cases underscore is the ability of even a few such cells to rekindle infection after prolonged remission,” Robert Siliciano said.

However, the authors conclude, “it is not too soon to begin planning for this type of ‘cure’ scenario.”