Testing for HIV
Infant cured of HIV, the headlines read. A medical miracle, it seemed.
Reports began to sprout Sunday of a little girl in Mississippi, “cured” of HIV. [Read here, here, here]
She was born to a mother who had not visited a doctor during her pregnancy; a mother diagnosed with the virus about the time she gave birth. The mother didn’t get the standard course of preventive antiviral treatment given to expectant HIV-positive women, which has helped reduce maternal transmission of HIV to fewer than 200 babies each year in the United States.
By the time she was 30 hours old, the baby had been sent to the University of Mississippi Medical Center. Dr. Hannah B. Gay, associate of pediatrics at the center and an HIV specialist, believing the infant was particularly at risk, commenced an unusual course of treatment.
Rather than give the baby prophylactic drugs, usually used to prevent HIV following potential exposure, Gay gave the baby a therapeutic combination of antiretroviral drugs. She started the regimen before lab tests even came back.
The AIDS virus is called a retrovirus because its genetic material exists as RNA, which gets converted to DNA once it infects a host. This works in reverse of the usual process.
Human Immunodeficiency Virus
Five tests in the baby’s first month of life, Gay and others said at the HIV meeting where the case was announced Sunday, showed she had HIV RNA and DNA in her blood.
She continued treatment and by the time the baby was a month old, the virus was undetectable.
But then, at the age of 18 months, mother and child disappeared. The baby did not receive her anti-HIV medicine for five months.
The HIV should have come back.
But it didn’t. When mother and baby returned, doctors could find no active HIV in the child’s blood.
The virus, the precursor to AIDS, usually goes into dormancy in the body for a period of time after initial infection, where it seemingly lies in wait. When a person consistently taking antiretrovirals to control it stops their regime, the virus can reemerge.
The toddler has now been off of the drugs for about a year and she is still virus free. The results have surprised many in the medical community.
Some have called it a game changer. Others, a miracle.
But this case is just an anecdote. A single child living with a symphony of unusual circumstances has emerged free of a deadly virus. It may not yet be enough to be called a game changer.
For one, any scientific study must have more than one subject to be statistically reliable. And the specifics of this child’s case have yet to be published in a peer-reviewed journal, where other experts can evaluate the circumstances and the findings.
What may have happened to her may not represent what would happen across a wider population of people.
Then there are experts uncertain as to whether the infant was ever truly infected.
The virus can take months before reliable detection is possible in infants. And infants, with their immature immune systems, are born with many antibodies from their mother. This infant would have possessed her mother’s HIV antibodies in her blood even if she wasn’t infected.
The doctors and scientists involved in this toddler’s situation believe the aggressive antiretroviral therapy Gay gave her helped prevent the virus from playing hide-and-seek in her body and going dormant.
But the mechanism of how this could have happened is unknown. Only time will tell if this child was truly cured, if she was ever really infected.
Science is a process. Absolute answers rarely emerge. The information can evolve over time, as new or different discoveries are made.
For now, a little girl is living HIV-free and scientists have a lot more questions to pursue.
Sources for story background: New York Times, USA Today, BBC
