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Toddler ‘Functionally Cured’ of HIV Infection

Discovery provides clues for potentially eliminating HIV infection in other children (Mar. 3)

A 2-year-old child born with human immunodeficiency virus (HIV) infection and treated with antiretroviral drugs beginning in the first days of life no longer has detectable levels of virus using conventional testing despite not taking HIV medication for 10 months, according to findings presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta, Georgia.

This is the first well-documented case of an HIV-infected child who appears to have been functionally cured of HIV infection — that is, without detectable levels of virus and no signs of disease in the absence of antiretroviral therapy.

Further research is needed to understand whether the experience of the child can be replicated in clinical trials involving other HIV-exposed children, according to the investigators.

“Despite the fact that research has given us the tools to prevent mother-to-child transmission of HIV, many infants are unfortunately still born infected. With this case, it appears we may have not only a positive outcome for the particular child, but also a promising lead for additional research toward curing other children,” said Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health (NIH).

In July 2010, the child was born prematurely in Mississippi at 35 weeks to an HIV-infected mother who had received neither antiretroviral medication nor prenatal care.

Because of the high risk of exposure to HIV, the infant was started at 30 hours of age on liquid antiretroviral treatment consisting of a combination of three anti-HIV drugs: zidovudine, lamivudine, and nevirapine. The newborn’s HIV infection was confirmed through two blood samples obtained on the second day of life; the samples were analyzed through highly sensitive polymerase chain reaction (PCR) testing. A diagnosis of HIV infection in an exposed infant is considered to be confirmed when PCR tests conducted on separate occasions indicate the presence of HIV.

The baby was discharged from the hospital at 1 week of age and was placed on liquid antiretroviral therapy consisting of combination zidovudine, lamivudine and co-formulated lopinavir/ritonavir. This drug combination is a standard regimen for treating HIV-infected infants in the U.S.

Additional plasma viral load tests performed on blood from the baby over the first 3 weeks of life again indicated HIV infection. However, by day 29, the infant’s viral load had decreased to less than 50 copies of HIV per milliliter of blood (copies/mL).

The baby remained on the prescribed antiretroviral treatment regimen until 18 months of age (January 2012), when treatment was discontinued for reasons that are unclear. However, when the child was again seen by medical professionals in the fall of 2012, blood samples revealed undetectable HIV levels (less than 20 copies/mL) and no HIV-specific antibodies. Using ultrasensitive viral RNA and DNA tests, researchers found extremely low viral levels.

Today, the child continues to thrive without antiretroviral therapy and has no identifiable levels of HIV in the body, using standard assays. The child is under the medical care of a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson. Researchers will continue to follow the case.

“This case suggests that providing antiretroviral therapy within the very first few days of life to infants infected with HIV through their mothers via pregnancy or delivery may prevent HIV from establishing a reservoir, or hiding place, in their bodies and, therefore, achieve a cure for those children,” said Deborah Persaud, MD, who led the analysis of the case.

Source: NIAID; March 3, 2013.

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