HIV-Infected Infant Potentially Cured Following Antiretroviral Drug Cocktail Regimen

Girl may be cured of HIV following antiretroviral drug cocktail
According to a recent study, published in the latest issue of NEJM, a young infant may have been ‘cured’ of HIV after administration of antiretroviral drug cocktail

A Mississippi girl, three years of age, may have been cured of human immunodeficiency virus (HIV) infection, following an aggressive round of treatment. Medical practitioners overseeing the girl’s case administered an aggressive cocktail of antiretroviral drugs, resulting in recent routine diagnostic tests returning negative results.

The case was originally reported back in March, during a medical conference in Atlanta. However, the group’s findings have been reported in much greater detail in the latest issue of the New England Journal of Medicine.

The young infant was born at 35 weeks gestation to a HIV-infected mother. The mother had received no prenatal care, with delivery of the baby taking place before administration of antiretroviral prophylaxis. Following laboratory testing, HIV DNA and RNA was detected in blood samples extracted from the mother, confirming that she was HIV positive.

In light of these findings, attending medical doctors immediately started the newborn on a three-drug antiretroviral regimen, comprising of zidovudine, lamivudine and nevirapine, 30 hours following birth. It was hoped that this course of drugs could serve as a potential prophylaxis against HIV infection, whilst preventing the development of resistant viral strains, in the event that the infant had been infected in utero.

Antiretroviral Cocktail Alleged to Have Interfered with HIV Reservoir?

Unfortunately, later blood tests revealed that the child was also infected with HIV. The doctors continued to ply the girl with a course of antiretroviral drugs, making substitutions to ensure drug resistance did not occur. The team systematically monitored the HIV RNA levels (copies/ml) in the baby on three successive occasions after birth. After six days,

HIV mechanism of infection
Diagram showing the basic mechanism of HIV infection, targeting T cells of the host’s immune system

the RNA level was 2617 copies/ml, reducing all the way down to just 265 copies/ml, at 19 days of age. When the child reached 29 days of age, the level of HIV RNA could not be detected using standard diagnostic tests (<20 copies/ml).

According to recent reports, it seems the young girl has not taken any antiretroviral medications for at least 18 months. Between 18 and 23 months of age, the child failed to attend a number of clinic appointments and, as testified by the mother, treatment had stopped when she was approximately 18 months of age. In spite of this, Dr. Deborah Persaud, of John Hopkins University School of Medicine, along with her colleagues, report no detectable levels of HIV RNA within the girl’s blood.

This result was confirmed after additional samples were taken from the young girl, which found no HIV antibodies at age 24, 26 and 28 months.

Typically, after antiretroviral therapy is stopped, a reservoir of HIV continues replicating rapidly and causes the viral load to rocket skyward. In explaining these amazing results, medical experts believe that replication-competent HIV reservoirs were either not initially established, with the virus unable to gain a foothold in the girl’s immune system, or were significantly abated by the rigorous antiretroviral course. In the published journal, the authors offer the following posit:

“This case suggests that very early ART [antiretroviral therapy] may interfere with either the quantities or qualities of persistent reservoirs of replication-competent virus.”

Perinatal HIV Infection a Major Public Health Issue

According to the Centers for Disease Control and Prevention (CDC), in 2010, the number of females with HIV, giving birth in the U.S., dramatically increased from between 6,000-7,000, in 2000, to 8,700, in 2006. Despite this increase, the actual number of perinatal cases of infection per year continues to decline, in each of the 50 states. It is suggested that preventative treatments have whittled down the number of babies born in the United States with HIV, each year.

The CDC outlines some of the major problems that are yet to be adequately addressed throughout much of America. The organization suggests that enhanced HIV prevention strategies could halt new infections within these populations, in turn, reducing cases of perinatal HIV infection. In addition, implementation of many of the following prevention strategies could help contribute to diminishing perinatal infections:

  • Preconception care at family planning institutions
  • Prenatal HIV testing
  • Routine administration of prenatal antiretroviral drugs in HIV-infected mothers
  • Avoidance of breastfeeding in HIV-infected mothers
  • Performing Cesarean deliveries for women with high viral loads
Number of perinatally acquired AIDS cases by year of diagnosis
Number of perinatally acquired AIDS cases, by year of diagnosis, in the U.S.

Globally, around 1,000 babies are born with HIV every day, representing a major health concern. All in all, nearly 70 million people having been infected with HIV since the epidemic was officially recognized, with around 35 million people having died from acquired immunodeficiency syndrome (AIDS). Researchers believe that this latest study may provide crucial knowledge that could help provide more effective policy for treating perinatally infected infants, who have not benefited from prophylactic treatment regimes.

Scott Hammer, of Columbia University in New York City, believes that the scientific community should remain cautious in interpreting the results of the study, as a single case may not be representative of the population as a whole. However, he calls for further studies to be conducted:

“The child described by Persaud et al. may be unique, and thus we have to exercise caution before inferring general principles from this case report. This said, we are at the stage at which individual case reports can provide proofs of principle, stimulate hypotheses, and lead to carefully designed experimental therapeutic studies involving both adults and children that, we hope, will lead us down the road to the reduction or eradication of the HIV-1 reservoir.”

By: James Fenner

New England Journal of Medicine Source

Centers for Disease Control & Prevention

World Health Organization

NEJM Rebuttal

Los Angeles Times