Mississippi doctors are reporting they have "functionally cured" a two-year-old child of HIV, according to findings presented at the Conference on Retroviruses and Opportunistic Infections (CROI) today. "Functionally cured" in this scenario means the child is now without detectable levels of virus and has not demonstrated any signs of the disease after 10 months without antiretroviral therapy. It's the first well-documented case of such results in an infant and only the second person overall documented with a cure. The first occurred in 2012 as Timothy Brown, later known as "the Berlin Patient," was cured through a bone marrow stem transplant.
Research on the case is still on going, and it has not yet been determined whether these results can be replicated in clinical trials with other HIV-exposed children. The National Institute of Allergy and Infectious Diseases (NIAID) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)—both components of the National Institutes of Health—provided funding to support the analysis presented at CROI. The child remains under the medical care of Hannah Gay, M.D., a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson.
When the child came back and showed no signs of HIV, Gay even thought it was a mistake. “My first thought was, ‘oh my goodness. We have been treating an uninfected child,” she told NBC News. "But I checked the records which confirmed she was, in fact, infected.”
The announcement's press release provided a detailed description of the child's background to date:
"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 and analyzed through highly sensitive polymerase chain reaction (PCR) testing. PCR tests conducted on separate occasions that indicate the presence of HIV in an exposed infant are considered to have confirmed the diagnosis of infection.
The baby was discharged from the hospital at one week of age and 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 United States.
Additional plasma viral load tests performed on blood from the baby over the first three weeks of life again indicated HIV infection. However, by Day 29, the infant’s viral load had fallen 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, the 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."