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A baby born with HIV in the United States has been ‘functionally cured’ of the virus, according to research presented yesterday at the Conference on Retroviruses and Opportunistic Infections (CROI).
The ‘Mississippi baby’ was born to an HIV positive mother who was unaware of her status and diagnosed late into labor. As a result, prevention of mother-to-child transmission (PMTCT) procedures could not be followed, and doctors initiated triple-combination antiretroviral therapy (ART) as a post-exposure prophylaxis; yet after sensitive tests were conducted, the baby was confirmed HIV positive. This continued to be the case up until 20 days of life, after which the virus was undetectable. The baby remained on triple-combination ART until 18 months, when treatment stopped because mother and child did not return to care. When the child returned to treatment at 23 months, it was found that the viral load was still undetectable despite having ceased treatment for 5 months. After further testing, they found a very small amount of inactive HIV in the body, in a state where it was unable to replicate and spread- ‘a functional cure’.
This case has garnered significant press attention, and whilst the findings are positive, it should be stressed that very little is known as to why this child has been able to eliminate reproduction of HIV in their body. As a ‘cure’, the model cannot be replicated among adults, or children who have been diagnosed later, as what seems to have worked in this case is a very aggressive attack on the virus, early into life, and before the virus had time to penetrate the CD4 cells. Further research needs to be done on whether or not early initiation of an aggressive ART in infants can be used as a last resort, when PMTCT procedures have not been followed. Also, as the child is still so young, further follow-up is needed to ensure viral replication does not begin later in life.
Ultimately, the focus should always be on PMTCT, rather than treatment of an infection or ‘cure’. We know that this is effective – through treatment provision, mother to child transmission is reduced to less than 5%, and is virtually eliminated in high-income countries
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