DOCTORS in the United States have made medical history by effectively curing a child born with HIV, the first time such a case has been documented.
The infant, who is now two and a half, needs no medication for HIV, has a normal life expectancy and is highly unlikely to be infectious to others, doctors believe.
Though medical staff and scientists are unclear why the treatment was effective, the surprise success has raised hopes that the therapy might ultimately help doctors eradicate the virus among newborns.
However, according to agency reports, AIDS experts cautioned media against raising expectations, stressing that much remained unclear -- including whether this may have been a freak result. “The world needs to see this as a proof of concept, but we are not anywhere near implementation” of similar treatment for all newborns at risk,” Harry Moultrie, a paediatric HIV researcher at the University of Witwatersrand, in South Africa, told news agencies. South Africa has a high share of infants born HIV-positive.
“One case does not make an intervention that you can just roll out,” said Moultrie, even as he hailed the result “a compelling description of a cure”.
Doctors did not release the name or sex of the child to protect the patient’s identity, but said the infant was born, and lived, in Mississippi state. Details of the case were unveiled on Sunday at the Conference on Retroviruses and Opportunistic Infections in Atlanta.
Dr Hannah Gay, who cared for the child at the University of Mississippi medical centre, said the case amounted to the first “functional cure” of an HIV-infected child. A patient is functionally cured of HIV when standard tests are negative for the virus, but it is likely that a tiny amount remains in their body.
“Now, after at least one year of taking no medicine, this child’s blood remains free of virus even on the most sensitive tests available,” Gay said.
“We expect that this baby has great chances for a long, healthy life. We are certainly hoping that this approach could lead to the same outcome in many other high-risk babies,” she added.
The mother was unaware she had HIV until after a test while she was in labour. “She was too near delivery to give even the dose of medicine that we routinely use in labour,” said Gay.
Doctors began treating the baby 30 hours after birth. Unusually, they put the child on a course of three antiretroviral drugs.
The traditional treatment to try to prevent transmission after birth is a course of a single antiretroviral drug. The doctor opted for the more aggressive treatment because the mother had not received any during her pregnancy.
Several days later, blood drawn from the baby before treatment started showed the child was infected, probably shortly before birth. The doctors continued with the drugs and expected the child to take them for life.
However, within a month of starting therapy, the level of HIV in the baby’s blood had fallen so low that routine tests failed to detect it.
The mother and baby continued regular clinic visits, but then began to miss appointments. The child had no medication from the age of 18 months, and did not see doctors again until it was nearly two years old.
“We did not see this child at all for a period of about five months,” Gay said. “When they did return to care aged 23 months, I fully expected that the baby would have a high viral load.”
Gay ordered several HIV tests. But she was stunned by the results. “All of the tests came back negative, very much to my surprise,” she said.
The case was so extraordinary, Dr Gay called a colleague, Katherine Luzuriaga, an immunologist at Massachusetts Medical School, who with another scientist, Deborah Persaud at Johns Hopkins Children’s Centre in Baltimore, found traces of HIV, but no viruses capable of multiplying.
The team believe the child was cured because the treatment was so potent and given swiftly after birth. The drugs stopped the virus from replicating in active immune cells, but also blocked the infection of other, long-lived white blood cells, called CD4. These CD4 cells behave like hideouts, and can replace HIV that is lost when active immune cells die.
The treatment would not work in older children or adults because the virus will have already infected their CD4 cells.
By arrangement with the Guardian
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