Last March, Mississippi doctors announced that early and aggressive treatment of an HIV-positive newborn had cured the child of her infection. Today, Los Angeles doctors reported that a second child may have been cured by a similar course of treatment, and could help prove that the Mississippi child's recovery was more than a stroke of luck.
Above: An SEM microcraph of HIV-1 budding from cultured lymphocyte
The case was presented today by doctors at at the 21st annual Conference on Retroviruses and Opportunistic Infections in Boston (last year's announcement came at the 20th annual CROI). Via the Associated Press:
The girl was born in suburban Los Angeles last April, a month after researchers announced the first case from Mississippi.
That case was a medical first that led doctors worldwide to rethink how fast and hard to treat infants born with HIV. The California doctors followed that example.
The Mississippi baby is now 3 1/2 and seems HIV-free despite no treatment for about two years. The Los Angeles baby is still getting AIDS medicines, so the status of her infection is not as clear.
A host of sophisticated tests at multiple times suggest the LA baby has completely cleared the virus, said Dr. Deborah Persaud, a Johns Hopkins University physician who led the testing [Ed. Note: Persaud was the lead author of the report recounting the Mississippi child's treatment at last year's Conference on Retroviruses and Opportunistic Infections]. The baby's signs are different from what doctors see in patients whose infections are merely suppressed by successful treatment, she said.
"We don't know if the baby is in remission ... but it looks like that," said Dr. Yvonne Bryson, an infectious disease specialist at Mattel Children's Hospital UCLA who consulted on the girl's care.
Doctors are cautious about suggesting she has been cured, "but that's obviously our hope," Bryson said.
Both children were born to HIV-positive mothers, neither of whom had taken the medications, typically administered during such pregnancies, that reduce the chances of passing the virus on to newborns. Both children were started on an aggressive antiretroviral treatment just hours after birth, too early for tests to reveal whether the newborns had actually been infected by their HIV-positive mothers (both, doctors in each instance later learned, had); and followup tests in both situations suggested the children had cleared their systems of the virus. One major difference: The Mississippi girl was treated until she was 18 months old, when doctors lost contact with her (when she returned ten months late, doctors found not trace of the infection in blood tests); the Los Angeles girl, however, is still being treated and carefully monitored.
It's encouraging how much the two cases have in common; if the ongoing treatment in the Los Angeles case proves successful, it could help prove that that the Mississippi case was no fluke. But even if the Los Angeles child does come away functionally cured of HIV, researchers will obviously require more than two cases to establish early and aggressive retroviral intervention as a standard therapy for babies at risk of HIV-infection. To that end, Bryson is heading up a study that will examine whether such treatment can, in fact, cure HIV infection in newborns. The study will reportedly involve about 60 neonates, from the U.S. and other countries, who will receive aggressive treatment for their first two years of life, only to have that treatment discontinued should traces of active infection cease to appear in blood samples.
"These kids obviously will be followed very, very closely" for signs of the virus, Persaud said.
More on this as it develops. In the meantime, here's the full writeup from the AP.