Curing Babies of HIV Within Hours of Birth (No Really)!

bornwithhiv

Last year,  an infant was pronounced to be “functionally cured” of HIV.  (See this story for an understanding on that) Unfortunately, the virus had returned by early this summer, but the treatment used on that infant has been considered so successful that the National Institutes of Health is about to start a large-scale trial to try to treat the infection within hours of an HIV-positive infant being born.

The thought here is that, when a baby is born, it has very low levels of the virus in its body. If treated with antiretrovirals immediately, it’s possible that the virus will never take hold, and the baby can, in theory, live a functionally HIV-free life.

Doctors involved with that first case— a Mississippi baby was HIV-free for 27 months—said that it “felt like a punch to the gut” when they discovered that the child had relapsed, but it later came out that that child stopped treatment for more than a year before again testing positive for HIV.

It’s not uncommon for patients to withdraw or stop receiving treatment in clinical trials—it’s currently unclear why that initial patient stopped being monitored and treated. If treatment is continued, however, it’s possible that the virus can be suppressed to the point where it doesn’t really have any impact on a person’s life.

BEING BORN WITH HIV DOESN’T MEAN HAVING TO LIVE WITH IT

“HIV typically takes just a few days to gain a permanent foothold in a newly infected person,” the National Institute of Allergy and Infectious Diseases director Anthony Fauci said in an emailed statement. “The theory behind this study is that starting antiretroviral therapy within hours of birth in newborns who became HIV-infected in the womb may limit how entrenched the virus becomes.”

Over the next several years,  472 babies in Africa, North, and South America who are infected in the womb will be treated within hours of being born. Antiretrovirals do have side effects, but they are generally considered mild and most commonly include diarrhea and nausea.

While antiretroviral drugs have had an amazing impact on life expectancy and managing the infection’s progression, it’s been impossible to use the drugs to truly cure the disease, because the virus continues to exist in a person’s body in what’s known as a “reservoir.”

“Although antiretroviral therapy can reduce the level of HIV in the blood to an undetectable level, latent reservoirs of HIV continue to survive,” the NIH explained. “When a latently infected cell is reactivated, the cell begins to produce HIV again. For this reason, ART cannot cure HIV infection.”

But the virus hasn’t built up its reservoirs in infants, so immediate antiretroviral therapy can limit the reservoir, which is what led to the “curing” of that child in Mississippi.

With more research, a longer initial treatment time, and closer monitoring, it’s possible that the success of that “Mississippi baby,” can be improved upon.

“Very early therapy may create conditions that enable the developing immune systems of HIV-infected infants to suppress the virus long term,” Rohan Hazra, a doctor at the National Institute of Child Health and Human Development said.

So, while we may still not have an HIV cure, we’re continuing to innovate how we treat it, and, increasingly, it’s looking like being born with HIV doesn’t mean having to live with it.

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