Functional cure of HIV-positive infant

Recent news reports across the world included the incredible information that a baby had been cured of HIV. Is this really true?

This news was presented at an HIV medical conference (Conference on Retroviruses and Opportunistic Infections) in Atlanta on March 4th.

Researchers reported that a 26-month old child, born with HIV and given antiretroviral drugs from when she was 30 hours old for about 18 months, no longer has detectable virus (using standard tests) after five months without treatment.

But, using very sensitive tests the researchers could still detect HIV at very low levels. This means the child has not been completely cured of HIV. This is what is called a “functional cure” – she is still infected but does not require treatment at the moment. It is not known whether her HIV might become detectable and she will need treatment in the future.

So how did this happen?

It is uncommon for babies to be born with HIV in Europe and America – where this child lives – as mothers are tested for HIV in pregnancy and treated with antiretrovirals if they are positive.

In this case, the mother’s HIV status was not discovered in time to give her antiretroviral treatment (ART) when she was still pregnant. HIV tests on the baby when she was two days old confirmed that she was also infected.

The baby was immediately given ART consisting of nevirapine, AZT and 3TC. She was tested (viral load test) at seven, 12 and 20 days after starting treatment and all these tests showed she had detectable virus. But when she was tested at 29 days she had an undetectable viral load. This continued to be undetectable until she was 18 months old.

Then the mother and child did not come back to the clinic for five months. When they returned to the clinic and the child was tested again, her doctors were surprised to find that her viral load was still undetectable, despite not having been on ART.

When the child was tested with very sensitive tests it was found that she still had very tiny amounts of HIV but not enough to be able to replicate itself.

The child has now been off treatment for a year and her viral load continues to be undetectable. 

Now researchers will look at whether a functional cure is possible for other babies in the same situation. This could lead to important new strategies for mothers and babies, particularly in poor countries where the majority of vertical transmissions take place.

According to the South African ARV and PMTCT guidelines, new born babies born to HIV positive mothers are given a dose of Nevirapine (NVP) immediately after birth. This is continued for 6 weeks. The baby will then be tested for HIV at 6 weeks. If the baby is HIV negative and breastfed, the baby continues NVP therapy until weaning. IF the baby tests HIV positive at 6 weeks it is then initiated on 1st line pediatric ART immediately.

Further reading:

If you want to find out more about this functional cure in an HIV infected baby, the Treatment Action Group’s Richard Jefferys has an excellent blog and has described this case in detail. He also regularly reports on other cure and basic science research.

The presentation is online (it is the seventh presentation in the session “Is there hope for HIV eradication”).