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HIV is detected in child thought to have been cured

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4614 (Published 14 July 2014) Cite this as: BMJ 2014;349:g4614
  1. Michael McCarthy
  1. 1Seattle

HIV has been detected in the blood of a child who was thought to have been cured of the infection after being started on a triple drug antiretroviral regimen shortly after birth, US health officials said last week.

The girl, known as the “Mississippi baby,” had been born prematurely in 2010 to an HIV infected mother whose infection had not been diagnosed until the time of delivery. The mother had received no prenatal care, and the infant was born prematurely at 35 weeks of gestation.1

Blood testing of the newborn baby detected both HIV-1 DNA in peripheral blood mononuclear cells and HIV-1 RNA in her blood, indicating that she had acquired the infection from her mother.

At 30 hours of age the infant was started on a three drug regimen of zidovudine (2 mg/kg of body weight every six hours), lamivudine (4 mg/kg twice daily), and nevirapine (2 mg/kg twice daily). At one week, ritonavir boosted lopinavir was substituted for nevirapine to reduce the risk of antiretroviral resistance in case of non-adherence.

She was continued on treatment until 18 months of age but then was lost to follow up. When she was seen again five months later, now 23 months old, blood samples showed undetectable HIV concentrations (less than 20 copies of HIV per mL of blood) and no HIV specific antibodies. According to the mother and pharmacy records, the child had stopped receiving treatment at the time she was lost to follow up.

The case was reported in the New England Journal of Medicine in November last year and had raised the hope that aggressive, early treatment might be a cure.2

Treatment was not restarted, and the girl remained free of detectable HIV for more than two years. However, last month routine follow-up testing of the child, now aged 4 years, found detectable HIV in the blood (16 750 copies/mL). Testing also showed that she had decreased concentrations of CD4+ T cells and antibodies against HIV. Genetic sequencing indicated that the virus was the same strain as that the child had acquired from her mother.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care, and the HIV and AIDS research community,” said Anthony S Fauci, director of the National Institute of Allergy and Infectious Diseases in a statement. “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 case, Fauci said, “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.”

He added, “Now we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged even further.”

Notes

Cite this as: BMJ 2014;349:g4614

References

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