The recent case of a child being cured of HIV in Missisippi is a new dawn in AIDS research
The recent case of a child being cured of HIV in Missisippi is a new dawn in AIDS research. Avantika Bhuyan speaks to medical experts to gauge the implications of this development
March 3, 2013. The whole world sat up in amazement as news came in about a functional cure that had been achieved for an HIV-infected infant in Mississippi. All eyes were focused on a team of researchers from Johns Hopkins Children's Center, the University of Mississippi Medical Center and the University of Massachusetts Medical School as they presented the case report in Atlanta at the 20th Conference on Retroviruses and Opportunistic Infections. Nearly 13 days have lapsed since the announcement was first made and already doctors are hard at work, interpreting and reinterpreting implications of the case.
While, on a medical front, this research may pave way to eliminating infection in children, but on a more humane level it represents hope to millions across the world infected with HIV. Doctors are hopeful that this particular baby will have great chances for a long and healthy life. "This baby will not need antiviral medication while her viral load remains below level of detection," says Hannah Gay, University of Mississippi Medical Center Associate Professor of Pediatrics, who treated this particular baby.
Many people are wondering what a functional cure really means. The report breaks it down: in contrast to a sterilising cure which is a complete eradication of all viral traces from the body, a functional cure occurs when viral presence is so minimal that it remains undetectable by standard clinical tests, yet discernible by ultrasensitive methods. Only one case of sterilising cure has been witnessed so far when Timothy Ray Brown was treated with a bone marrow transplant for leukemia in a surgery conducted in 2007. "The bone marrow cells were taken from a donor with a rare genetic mutation of the white blood cells that rendered some people resistant to HIV," mentions the report that was presented in Atlanta. However, it is not feasible to replicate this treatment model for the millions infected with HIV globally, thus making the Mississippi cure all the more significant.
* * * * *"Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy (ART) or something we can actually replicate in other high-risk newborns," said Johns Hopkins Children's Center virologist and lead author of the report, Deborah Persaud, at the conference. She is also the scientific chair of the HIV Cure Committee of the International Maternal, Pediatric Adolescent AIDS Clinical network, a consortium of researchers and institutions that was critical in spearheading the earliest clinical trials of mother-to-child transmission and early treatment of infants 15 years ago.
* * * * *According to the National AIDS Control Organisation (in technical report, India HIV estimates 2012), it is estimated that about 142,000 (range: 111,000 to 183,000) children were living with HIV infection in 2011. It is believed that of these, 34 per cent children are already receiving ART, while 86,000 of them may be requiring ART. So, as Paranjape maintains, that this functional cure will be of minimal use to those children who are already infected and are living with HIV infection that they acquired from their infected mothers. "Longer follow up of this particular baby will be required to understand the full implications. Furthermore, these findings have very little implication to the adult situation as of now," he says.
THE LANDMARK CASE
According to the report presented by the investigative team at CROI, the infant underwent remission of HIV infection after receiving ART therapy within 30 hours of birth. The prompt administration of antiviral treatment led to the infant's cure by halting the formation of hard-to-treat viral reservoirs or dormant cells responsible for re-igniting the infection in most HIV patients within weeks of stopping therapy.
A series of tests showed progressively diminishing viral presence in the infant's blood, until it reached undetectable levels 29 days after birth. The infant remained on antivirals until 18 months of age, at which point the child was lost to follow-up for a while and, the researchers say, stopped treatment.
Ten months after discontinuation of treatment, the child underwent repeated standard blood tests, none of which detected HIV presence in the blood. Test for HIV-specific antibodies - the standard clinical indicator of HIV infection - also remained negative throughout.
* * * * *According to him, a second breakthrough has been the clear proof that treatment is an effective way to prevent transmission of HIV, so that the more people take to ART consistently, the fewer new infections will occur. "The costs of HIV treatment have also fallen greatly for the first line treatment, which once cost thousands of dollars per month and now costs around $100 per year. Nonetheless, the success of the scale-up means that the funding needed to produce and deliver the medicines is still considerable and second and third line treatments are still much too expensive,' he explains.
Indian businessmen and philanthropy have never walked hand in hand. But change is in the air