A toddler who scientists believed was functionally cured of HIV after receiving anti-retroviral therapy within days of her birth has shown detectable levels of the HIV virus, according to the doctors who are treating her.
The child, whose mother didn’t know she was infected with HIV until she was in the delivery room, has been referred to as the Mississippi baby in order to protect her identity. Her case, published in a 2013 New England Journal of Medicine paper, was touted as an example of long-term HIV remission.
The news dashed the hopes of scientists that early treatment with HIV drugs could reverse the course of the virus.
"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," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in a release. "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.”
After her birth in a Mississippi clinic in 2010, the baby received anti-retroviral therapy starting just 30 hours after she was born, which continued until she was 18 months old. Doctors then lost contact with her for a few months, but when she went in for a checkup five months later, they couldn’t detect the virus or HIV-specific antibodies in her blood, even though the mother had stopped giving the baby the anti-retroviral drugs.
For more than two years, the baby remained HIV-free and did not take HIV drugs. But during a routine doctor visit earlier in July, doctors detected HIV in her blood, and after confirming the results with a second test, they once again began to treat her with anti-retroviral therapy.
“Ever since we discovered this case in 2012, we knew this could happen,” Hannah Gay, a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson who treated the child, told USA Today.
But the girl’s relapse felt like a “punch in the gut” anyway, Gay told the newspaper.
Still, the fact that the baby remained HIV-free for two years without any anti-retroviral treatment is “unprecedented,” according to Dr. Deborah Persaud, an infectious diseases professor at the John Hopkins Children’s Center in Baltimore and one of the two pediatric HIV experts who has continued to analyze the child’s case. “Typically, when treatment is stopped, HIV levels rebound within weeks, not years,” she said in a release.
Fauci said that NIAID and the National Institute of Child Health and Human Development, which have been analyzing the case, will continue to try to find out why the virus was in remission for so long and whether early anti-retroviral treatment might be able to keep the virus at bay for even longer periods.
Because the mother didn’t know she was infected with HIV while pregnant, she didn’t take anti-retroviral drugs to prevent transmission of the virus to the baby, which the National Institutes of Health recommends for HIV-positive pregnant mothers.
Earlier in 2014, doctors revealed that a second HIV-infected baby in California who was given HIV drugs just four hours after she was born appeared to be free of signs of the virus about a year later, though the baby is still taking anti-retroviral drugs.
And a San Francisco man, Timothy Ray Brown, is believed to have been cured of HIV after he received a bone marrow transplant from a donor who had a rare HIV-resistant gene mutation.