It is estimated that 34 million people are infected with HIV, the virus that causes AIDS each year. Approximately 25 million have died from the condition. But contrary to what some may believe, the virus itself is not what kills AIDS patients. Rather, the virus causes damage to the immune system. This, in turn, leads to infections that are difficult and sometimes impossible to treat. It is those infections that cause fatality in AIDS patients.
At this time, there is no vaccine to prevent HIV and there is no cure. HIV patients can take a powerful cocktail of antiviral drugs (called antiretroviral therapy, or ART) that help keep the virus at bay. But regardless of how long the patient takes their medications, the virus lurks and remains in their system. And in most cases, it can still be detected. So, if an AIDS patient stops taking ART medications, the virus will come back full-force.
Like adults, babies can be infected with the virus. Most often, this occurs because the mother is HIV positive. The baby can then become infected during birth. But babies are a little different in the way of treatment. Doctors know the exact moment that a baby has become infected, which allows them to treat with drugs immediately. Generally, they are given a low dose to start and then doctors wait about six weeks to see if the infection has actually developed before choosing whether or not to treat them again.
Done right around birth, this type of treatment can prevent about 95 percent of neonatal infections. But even for babies, ART medication is required to maintain long-term health. And the virus is still detectable. It is because of these known facts about HIV in children that doctors are now talking about a cure after a little girl, born with HIV, managed to test as “undetectable,” even after missing at least eight months of ART drugs.
Like most mothers, this infant’s mother was unaware of the fact that she had the virus until it came time to deliver. Doctors immediately gave the mother a standard dose of HIV drugs, which has been shown to prevent mother-to-child transmission. But it doesn’t always work, and in this case, it didn’t. The baby, who was born premature, was tested 30 hours after birth; doctors found clear evidence of the virus. But then they opted to do something a little out of the ordinary; they gave her a cocktail of three drugs at a dose that is normally reserved for more advanced cases.
Shortly after, the little girl was tested again. Her virus had levels had been pushed down to what doctors call “undetectable.” This simply means that the virus cannot be found within the blood, which means that it isn’t spreading and it isn’t damaging the immune system. Usually, the virus does pop back up later, which is why the drugs are necessary. So, like other children infected with the virus, this little girl continued treatment.
Dr. Hannah Gay at University of Mississippi Center saw the little girl until she reached 15 months old. Then she disappeared off the doctors’ radar. Gay said that the mother had brought the little girl back to the hospital briefly at 18 months, but then she disappeared again. Again, the baby returned, this time at 2 ½. All in all, she missed at least eight months worth of ART treatment. Imagine Gay’s surprise when she couldn’t find any trace of the HIV virus in the little girl’s system, and what’s more, the little girl appeared to be healthy.
“My first thought was, ‘oh my goodness. We have been treating an uninfected child,” Gay told NBC News. “But I checked the records which confirmed she was, in fact, infected.”
Dr. Katherine Luzuriaga of the University of Massachusetts Medical School, who worked on a study that followed this little girl, conducted a battery of tests on the little girl, including a sensitive test called PCR. This test has the ability to find even tiny bits of genetic material for a virus, but even it came back as negative. In the world of HIV testing and treatment, this little girl’s case went well beyond the typical definition of “undetectable.” There really wasn’t any evidence that the girl had ever had the virus in the first place.
“What we did then was to get a group of collaborating laboratories together to apply ultra-sensitive testing and say ‘can we detect any evidence of the virus,’” Luzuriaga told NBC News.
Eventually, they did find some pieces of genetic material from the virus, but even with that, there is no evidence that the virus has any ability to invade cells or replicate, despite the fact that she’s remained off of treatment. Now they are just watching and following the little girl to see if the virus comes back.
“What we have identified is what we think is the first well-documented case of a functional cure in a neonatal child,” Dr. Deborah Persaud of the Johns Hopkins Children’s Center, the virologist who led the study on the little girl, told NBC News. “This has major implications for how we begin to think about treating children. Perhaps we can spare them a lifetime of treatment.”
It’s not a real cure, but it does give doctors hope for what they call a “sterilizing” or functional cure, which basically means that the virus, while still there, isn’t doing any damage. It’s not spreading from one cell to the other, and it’s not causing a breakdown of the immune system. At this time, it’s the best that doctors can hope for in an HIV patient, and considering the alternative, that’s a pretty amazing option.
Unfortunately, this is just one patient. One child.
“We need to figure out if this can be reproduced or replicated in other infants,” Persaud said. “Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns.”
Only one other person in the world has ever been documented with a cure; a patient from Berlin, Timothy Brown. He was treated for leukemia with a bone marrow transplant that came from a donor who had a genetic mutation that makes the immune system cells resistant to the HIV infection. He has remained virus free for five years, but others that received the same treatment haven’t shown the same promise. Two are “doing fine,” according to Dr. Dan Kuritzkes of Brigham and Women’s Hospital and Harvard Medical School, but they are still on their ART medications. Sadly, a third patient who was also treated with a transplant ended up suffering a relapse and dying of lymphoma.
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