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Functional Cure for HIV-Infected Infant After Very Early Treatment

March 3, 2013

A 26-month-old infant girl born in Mississippi has been functionally cured of HIV, according to results presented at CROI 2013 in Atlanta.

According to lead author Deborah Persaud, M.D., the infant was treated very early, within 31 hours of life, with zidovudine/lamivudine (AZT/3TC, Combivir) and nevirapine (Viramune). After a week, the nevirapine was switched out for lopinavir/ritonavir (Kaletra).

While HIV testing and prenatal treatment is standard for pregnant women in the U.S., the infant's mother was not in care during her pregnancy.

The mother, who was unaware of her HIV status, was confirmed infected using standard rapid tests during labor and delivery. Within 30 hours, the baby was transferred to the University of Mississippi Medical Center, where Hannah Gay, M.D., administered two separate HIV tests: a nucleic acid test at 30 hours and a viral load test at 31 hours.

The test results didn't come back until days later, but based on the mother's prior lack of HIV care, Gay decided the risk of mother-to-child HIV transmission was too great, and made the highly unusual decision to start the child on a full antiretroviral regimen immediately.

Within a week, the nucleic acid test came back positive and the viral load test revealed the child had a viral load of about 20,000 copies/mL. Persaud noted that the two positive tests are the standard definition of HIV infection in a perinatally exposed child and therefore justified the decision to start the infant on HIV treatment.

Within a month, the baby's viral load had lowered to undetectable levels. After 18 months of treatment, the mother decided to take the child off treatment. Despite this treatment discontinuation, the infant has continued to have an undetectable viral load through 26 months of age. Although HIV DNA fragments have been found in the baby's blood in extremely small amounts, there has been no sign of any actively replicating virus.

"Plasma viral load, PBMC (peripheral blood mononuclear cells) DNA, and HIV-specific antibodies remained undetectable with standard clinical assays, confirming a state of functional HIV cure," the researchers state in the study abstract. They theorize that very early treatment could have stopped the virus from forming reservoirs that cannot be eliminated with existing antiretrovirals; the existence of those reservoirs has thus far proven to be the primary roadblock to HIV eradication in chronically HIV-infected patients.

Dr. Persaud noted that this case appeared to be different from post-exposure prophylaxis (PEP) because the infant showed detectable levels of virus prior to treatment initiation, thus suggesting she was probably infected in the womb rather than during delivery.

For thoughtful analyses of the importance of this study and its significance for the HIV community, read this reaction article by Paul Sax, M.D., as well as this op-ed by Jim Merrell of the HIV Prevention Justice Alliance on the questions this story raises about the U.S. health care system.

Warren Tong is the research editor for and

Follow Warren on Twitter: @WarrenAtTheBody.

Copyright © 2013 Remedy Health Media, LLC. All rights reserved.

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Reader Comments:

Comment by: Mohammed y (Nigerian) Sun., Mar. 10, 2013 at 9:58 am UTC
welldone for the good job,i really enjoyed the aeticle.
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Comment by: Carolina (Belo Horizonte, Brazil) Fri., Mar. 8, 2013 at 12:02 pm UTC
I wonder if it was taken into account that viral load under 20,000 is not specific for HIV infection.
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Comment by: Rob (Montreal, Canada) Thu., Mar. 7, 2013 at 2:11 pm UTC
This make my heart beat faster with hope that we may be one step further on that long road to finding a cure.
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Comment by: Lucky M (Johannesburg, South Africa) Tue., Mar. 5, 2013 at 6:03 am UTC
Age- and Disease-Dependent HERV-W Envelope Allelic Variation in Brain: Association with Neuroimmune Gene Expression 2010

By the age of 2 and a half the HIV tests may not be able to pick up the retroviral phenomena anyway unless a child was sick and was expressing retroviruses due to illness.

So pulling a HIV diagnosis on a child is like pulling a rabbit out of a hat because children are full of retroviruses anyway and retroviruses are always there and by the age of 2 most of the retroviral activity has slowed down regardless of medications.
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Comment by: Lucky M (Johannesburg, South Africa) Tue., Mar. 5, 2013 at 6:01 am UTC
DNA-abzymes and their clinical significance in systemic lupus erythematosis

And even of more interest is that pregnant women with autoimmune disorders can have the highest level of abzyme activity in that they are dealing with a cell growth explosion from having a baby and all the retroviral activity of that coupled with the retroviral activity that accompanies autoimmune diseases.

"The DNase activity of IgG and IgM from blood of healthy pregnant women was 4-5 times less than that from pregnant women with pronounced autoimmune thyroiditis"

So the abzymes in breast milk are needed to slow down a lot of cellular activity and I presume our abzymes snip up potentially dangerous strands of DNA and RNA.
Really this is new research but it seems ridiculous to have this 'HIV could be transmitted via breast milk' belief whereHIV+ mothers have gone to jail for breastfeeding when the very antiretroviral abzymes plus other antibodies needed to get the child started are in the breast milk and this is how things were always done.

"In humans, pregnancy and lactation are associated with the production of catalytically active antibodies (abzymes) in serum and breast milk."
Catalytic nucleotide-hydrolyzing antibodies in milk and serum of clinically healthy human mothers. 2004
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Comment by: Lucky M (Johannesburg, South Africa) Tue., Mar. 5, 2013 at 5:59 am UTC
This is ridiculous rubbish from HIV scientists who don't know anything and don't want to learn about retroviral functions in our bodies.

When babies are born their retroviruses are more active because the retroviruses are involved in cell growth.

"Expression of Reverse-Transcriptase-coding genes is generally repressed in non-pathological, terminally differentiated (adult) cells, but is active in early embryos, germ cells, embryo and tumor tissues, all of which have a high proliferative potential."
Endogenous reverse transcriptase: a mediator of cell proliferation and differentiation. 2004

So the normal sequence of events in pregnancy is the baby gets antiretroviral antibodies called catalytic enzymes or abzymes via the mother's breast milk, this is needed to slow down the cell growth post birth as too much growth can be as bad as none at all.

"In human milk we previously found catalytic antibodies (abzymes) catalyzing hydrolysis of DNA, RNA, NMP, NDP, and NTP and also phosphorylation of proteins and lipids. In the present study we have analyzed nuclease activities of antibodies in blood of women during pregnancy and lactation. Blood of healthy male and female volunteers lacked catalytically active antibodies, whereas antibodies from blood of pregnant women hydrolyzed DNA and RNA and their relative activity varied over a wide range. Relative blood abzyme activities significantly increased after delivery and at the beginning of lactation. The highest abzyme activity was observed in blood of parturient women."
Dynamics of antibody nuclease activity in blood of women during pregnancy and lactation. 2003

These enzymes were postulated years before by Linus Pauling and recently became the buzz word in 'A Cure for 'HIV''.
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Comment by: T.rex (Los Angeles) Mon., Mar. 4, 2013 at 4:54 pm UTC
I don't understand... This very site claims that babies carry on the mom's antibodies for a few years, regardless of infection... So ALL babies born to HIV+ moms will also test HIV+ until those antibodies fade away.

In fact, I've read on this very site that its useless to even test a baby for HIV until they are like 2 years old.

To me, sounds like the docs pumped a healthy infant full of toxic drugs, and now rather than face a lawsuit, are claiming the baby is cured.
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Replies to this comment:
Comment by: Warren ( Wed., Mar. 6, 2013 at 12:39 pm UTC
Actually, the baby tested positive for HIV DNA and RNA on two separate blood draws, which as Dr. Persaud noted is the standard definition of HIV infection in babies.

Comment by: adam kalema (mangochi,malawi central africa) Mon., Mar. 4, 2013 at 2:06 pm UTC
i thank the God almighty for his mecry and knowing that one day there will be no one with h.i.v and aids,i was very happy reading the amazing story.
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