Cure or fluke? Researchers question HIV results

Compiled by Kate Bennion

For the Deseret News

Published: Wednesday, March 6 2013 7:55 p.m. MST

This image provided by Johns Hopkins Medicine shows Dr. Deborah Persaud of Johns Hopkins' Children's Center in Baltimore. A baby, born with the AIDS virus, appears to have been cured scientists announced Sunday, March 3, 2013, describing the case of a child from Mississippi, who's now 2½ and has been off medication for about a year with no signs of infection. If the child remains free of HIV, it would mark only the world's second known cure. Specialists say the finding offers exciting clues for how to eliminate HIV infection in children. "Maybe we'll be able to block this reservoir seeding," Persaud said.

Johns Hopkins Medicine, Associated Press

Enlarge photo»

Earlier this week, the news that a baby had been "cured" of HIV startled the medical community and made headlines around the world.

However, while remarkable, scientists and researchers question whether the Mississippi case is as much of a "miracle" as it seems and if it will reap immediate benefits or provide practical application for HIV treatment.

One cause for doubt is the issue of whether the baby was ever truly infected with the virus. According to Dr. Steven Deeks, AIDS researcher at UCSF, "There was virus around, but the cells being infected weren't the type that become long-lived reservoirs."

In more established infections, such "reservoirs" last for years, with HIV hiding in immune-system cells and making complete eradication of the virus impossible.

"What is probably happening is that latency is being prevented, not reversed," Deeks told the Wall Street Journal.

Another source of concern is that according to ultra-sensitive tests administered on the baby, the child still has some remaining HIV virus — not enough to actively reproduce, but it's still enough to make some scientists doubt.

"That’s not nothing," writes Dr. Kent Sepkowitz for The Daily Beast. "Ten months of stability is but a moment of time for HIV, for which progression is measured in years. Therefore, 'cure' or even 'functional cure' seems a reach. A stable suppression in the absence of ongoing therapy would be a more accurate description — and one that likely would have been used in a less dramatic and headline-grabbing disease."

Finally, a way to prevent transmission to newborns already exists. The aggressive treatment with antiretroviral drugs by the doctor were a secondary measure because the Mississippi mother had not been tested and treated earlier — otherwise, the baby's infection would have been almost completely preventable.

"The Mississippi baby became infected because the mother had not been tested in early pregnancy. If she had, the woman would have been put on antiretroviral drugs, the baby would have been delivered by cesarean section and then given a short course of drugs — all of which would almost certainly have prevented transmission of HIV from mother to child," wrote Sarah Boseley for the Guardian.

Even though treatment before delivery is the best way to ensure newborns aren't infected, 100 to 200 babies are still born each year in the U.S. with HIV. Up to 1,000 infected newborns are born each day worldwide.

The treatment used in Mississippi, however, may not be practical elsewhere, especially where resources are limited.

"It might seem as though the Mississippi baby breakthrough will, therefore, save thousands of lives in the 25 countries in sub-Saharan Africa, where most of these infections are taking place," wrote Boseley. "But there is already a way of preventing these infections using drugs — which is far better than a functional cure using similar drugs.

"The problem is not how to do it — it is to ensure the drugs and the medical staff are in the right place at the right time to treat mother or baby or both. There are plenty of pregnant women in Africa known to have HIV who cannot get the treatment they want and need to protect their child. It is not very likely that the clinics they attend will instead have the three-drug combinations that the Mississippi baby received from skilled nursing staff within hours of birth."

EMAIL: kbennion@deseretnews.com

Get The Deseret News Everywhere

Subscribe

Mobile

RSS