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Toddler ‘Functionally Cured’ of HIV Now Has Detectable Disease, Researchers Find

NIH announces disappointing news

The child known as the “Mississippi Baby” — an infant seemingly cured of human immunodeficiency virus (HIV) infection whose case was reported in the New England Journal of Medicine last fall — now has detectable levels of HIV after more than 2 years of not taking antiretroviral therapy without evidence of virus, according to a report from the National Institutes of Health (NIH).

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care, and the HIV/AIDS research community,” said Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Disease (NIAID). “Scientifically, this development reminds us that we still have much more to learn about the intricacies of HIV infection and where the virus hides in the body.”

The NIAID and the National Institute of Child Health and Human Development (NICHD), both a part of the NIH, provided funding to the researchers involved in the analysis of the case and will conduct a clinical trial to build on the findings. The researchers planning the clinical study will now need to take this new development into account.

The child was born prematurely in a Mississippi clinic in 2010 to an HIV-infected mother who did not receive antiretroviral medication during pregnancy and who was not diagnosed with HIV infection until the time of delivery. Because of the high risk of HIV exposure, the infant was started at 30 hours of age on liquid, triple-drug antiretroviral treatment. Testing confirmed within several days that the baby had been infected with HIV. At 2 weeks of age, the baby was discharged from the hospital and continued on liquid antiretroviral therapy.

The baby continued on antiretroviral treatment until 18 months of age, when the child was lost to follow-up and no longer received treatment. However, when the child was again seen by medical staff 5 months later, blood samples revealed undetectable HIV levels (fewer than 20 copies of HIV per milliliter of blood) and no HIV-specific antibodies. The child continued to do well in the absence of antiretroviral medications and was free of detectable HIV for more than 2 years.

However, during a routine clinical care visit earlier this month, the child, now nearly 4 years old, was found to have detectable HIV levels in the blood (16,750 copies/mL). Repeat viral-load blood testing performed 72 hours later confirmed this finding (10,564 copies/mL of virus). In addition, the child had decreased levels of CD4-positive T-cells, a key component of a normal immune system, and the presence of HIV antibodies — signals of an actively replicating pool of virus in the body.

Based on these results, the child was again started on antiretroviral therapy. To date, the child is tolerating the medication with no side effects, and the treatment is reducing virus levels. Genetic sequencing of the virus indicated that the child’s HIV infection was the same strain acquired from the mother. The child continues to receive medical care, treatment, and monitoring at the University of Mississippi Medical Center in Jackson.

“The case of the Mississippi child indicates that early antiretroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period,” Fauci said. “Now we must direct our attention to understanding why that is and to determining whether the period of sustained remission in the absence of therapy can be prolonged even further.”

Sources: NIH; July 10, 2014; and NIH; March 3, 2013.

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