Then there were two? Physician researcher presents the very different case of functionally cured toddler

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Science Speaks is in Atlanta, Georgia this week and will be live-blogging from the 20th CROI — Conference on Retroviruses and Opportunistic Infections from Sunday to Wednesday, covering breaking developments from investigators on cure research, new antiretroviral agents, hepatitis, tuberculosis and treatment as prevention.

PersaudATLANTA, GA — To put this in perspective, about 70 million people have been infected with HIV in the more than 30 years since the AIDS epidemic was recognized, clinician and scientist Dr. Deborah Persaud said Monday morning. She was in front of an audience of rows of researchers crowding a session on how HIV can ever be eradicated from a person who has been infected with it,.

Only one had been cured: Timothy Brown, the Berlin patient. His story, while it has energized the field of cure research, is not one that is likely to be repeated; he nearly died in the process of getting the bone marrow transplant that eliminated all of the replicable HIV in his body.

If, on the other hand, what happened to the baby, who Persaud and other researchers from Johns Hopkins University School of Medicine,  along with a list of research centers referred to as  “a case of functional HIV cure in a 26-month-old infected child who initiated ART at 30 hours of age”,  proves to be replicable, the implications for treatment of children born with the virus  are vast.  They could, researchers agreed, change everything.

The baby, born to a mother who had no prenatal care, and who tested positive for HIV shortly before giving birth, was born with the virus, which was determined twice in separate blood samples. For that reason, the child was given antiretroviral drugs not as prevention, but as treatment – that is therapeutic, rather than preventive doses of one of the medicines. Followed by physicians for the next 18 months, the infant did well, and as is common among young children on highly active antiretroviral treatment, achieved undetectable viral loads.

But just as the cure of Timothy Brown owes much to his misfortune of getting leukemia, what happened next with this child hinged on what could  have been expected to have tragic consequences: for the next five months the child was lost to followup. Researchers are not certain even now if the baby’s treatment was discontinued before that, possibly at 15 months, but are using what they know – from the age of at least 18 months to the age of 23 months, the child was given no treatment for HIV.

The test to check the child’s viral load turned out to be the first in what became a battery of wide-ranging tests. That is because, improbably, the child’s viral load after at least five months with no treatment remained undetectable, although it could have been expected to rise in a matter of weeks. Subsequent tests showed no antiretroviral drugs in the child’s system, while more sensitive tests to find HIV also had negative results. Doctors also tested mother and child’s DNA to make sure they were, in fact looking at the same child.

In the end, so far the tests indicate that a child who was facing a lifetime of treatment for HIV will not need it.

And that is where the implications for other children come in. You  do the math.







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