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TheBodyPRO.com covers CROI 2013

Exploring the Media Fascination With the Baby Cured of HIV

March 5, 2013

As undoubtedly you've heard by now, there's another person cured of HIV out there -- this time, it's a baby born to an HIV-infected mother.

Here's the story: The mother didn't know she was HIV positive until delivery, and the baby was found to be infected by both HIV DNA and RNA right at birth. The doctors started combination antiretroviral therapy approximately one day later, essentially as soon as the results came back. There was a good response to treatment, with declining HIV viral loads over the next few weeks that quickly became undetectable.

Successful treatment continued for 18 months, at which time mom and baby were lost to follow-up; the mom stopped the baby's antiretrovirals. When the two returned to care 5 months later, the baby's HIV RNA and antibody were both negative -- much to the surprise of the doctors. Supplemental testing, using evaluations similar to those done on the Berlin patient, did not yield any evidence of replication-competent virus, and the baby remains off therapy today.

In short, baby cured of HIV. Stop the presses!!! (Do they still say that?) Front page story, New York Times. Look at this Google News Page and the search gadget at the top of this post! Here at CROI, my colleagues and I are all getting e-mails from our friends/family/etc. asking about this "breakthrough."

And we're kind of baffled. Because this case will have about as much immediate impact on the HIV epidemic in the United States as the prior cure -- that's right, virtually none. Maybe it will have an impact globally, but that will be a major challenge.

Thinking about it more, however, I understand why this is such compelling news:

  • It's a baby. The media love stories about HIV in babies. The whole "innocent victim" thing is hard to shake.
  • It's a cure. Can't miss that. And the press is probably hypersensitive about not missing out, since they initially whiffed on reporting the last HIV cure. It was first presented at CROI in 2008 and barely got a peep. Took a resuscitation of the story by the Wall Street Journal and, ultimately, publication in the New England Journal of Medicine for the case to receive major media attention. For the record, rumor has it that a certain highly prestigious medical journal (hint) also initially whiffed on it, rejecting the case report when it was first submitted.
  • The public probably doesn't really understand that HIV in babies is all but 100% preventable. Not emphasized nearly enough in most of the media reports is that the mom didn't know she was infected until delivery, so she missed out on the key intervention for preventing HIV transmission -- treatment of the mom during pregnancy. And since treating pregnant women has long been standard-of-care, pediatric HIV in the United States is vanishing, a real triumph of prevention. Fewer than 200 cases/year in this country, and counting (down).

So what are the practical implications of this case?

First, in developing countries with high HIV prevalence, where perinatal transmission remains a problem, strategies to aggressively treat the newborns of untreated HIV-positive mothers should be implemented pronto. Second, the case will probably teach us a bit more about how we might someday actually cure more than just a single person here and there.

But for now, the headline to this USA Today piece -- "Child's HIV Cure Won't Mean New Treatments Immediately" -- is the understatement of the year.

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

Read TheBodyPRO.com's multi-author blog, HIV Care Today.


Related Stories

Behind the Miracle Cure a Broken System Lurks
Functional Cure for HIV-Infected Infant After Very Early Treatment



This article was provided by Journal Watch. Journal Watch is a publication of the Massachusetts Medical Society.
 


Reader Comments:

Comment by: Truth x2 (Southeast) Wed., Mar. 13, 2013 at 12:16 am EDT
Truth Teller: The only person pointing fingers within this website is you. The article itself, as well as the scientific presentation of the case study, is factual and judges no one. Individual responsibility has no role or even need for mention here, in this article that simply shares important medical information with far-reaching implications.
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Comment by: lenet (Nairobi -kenya) Sun., Mar. 10, 2013 at 1:07 pm EDT
This is the best news of the year. Early initiation of ART for HIV babies is essential even in developing countries like Kenya. Hoping the initial test did not give false positive result which could be a probability but hope not since both RNA and DNA tests were positive.
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Comment by: Ivan A (Cabo Rojo PR) Thu., Mar. 7, 2013 at 4:18 pm EST
Considering the millions who are infected worldwide the FDA and Big Pharmacueticals is not likely to relinquish its hold on its cashcow. The equation is simple. Infection= lifelong dependence on drugs = $$$
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Comment by: Truth Teller (Midwest, USA) Thu., Mar. 7, 2013 at 1:00 pm EST
Yeah, yeah. It's everyone's fault EXCEPT the "young" mother as you call her. The same person who didn't get prenatal care, who is hiv+ and didn't get tested, who got pregnant and disappeared for several months while NOT getting her child care and meds THAT WAS ALREADY ESTABLISHED! Where did she go? Because of this chain of events we now have learned a lot of wonderful information and it will change the way infants are treated going forward, thankfully, but give me a break. The failure of the richest country in the world to provide medical care? She had care, she just decided not to continue it. Did she seek continued care? Who was providing the care for this mother and child after she delivered? Was she employed? Did she have insurance? Was she on welfare? Medical assitance? The "young" mother needs to take accountability for her irresponsible behavior and you need to open your eyes and address all the issues, not just the ones that promote your agenda. This type of one-side, blame shifting, finger pointing reporting not only makes reasonable thinking people examine your credibility and does nothing to draw attention to the larger issues of education and individual responsibilty.
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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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