Was a Baby Cured of HIV?
At the annual Conference on Retroviruses and Opportunistic Infections (CROI) held in the U.S. in March 2013, researchers presented details of the case of a baby that was apparently cured of HIV infection. Claims of apparent cures of HIV are rare and because of their potential importance they deserve a high level of scrutiny and critical thinking.
The research team reported on a mother in the southern U.S. who sought care because she was about to give birth. They stated that "she had not been engaged in prenatal care" and so doctors did not know that she was HIV positive until she prematurely entered labour, when they performed rapid HIV testing. Her HIV viral load was low (2,423 copies/ml) and her CD4+ count was relatively high (644 cells). Analysis of her HIV suggested that it had not encountered anti-HIV drugs.
Assuming that the baby was also infected, doctors sent the infant to a major hospital for care. There, 31 hours after birth, researchers found that the baby had HIV-infected cells in its blood and its viral load was 19,812 copies/ml. Doctors immediately began anti-HIV therapy with nevirapine (Viramune), AZT (Retrovir, zidovudine) and 3TC (lamivudine). After a week, nevirapine was replaced with lopinavir-ritonavir (Kaletra). The baby responded well to treatment and a month after birth its viral load was less than 48 copies/ml.
After 18 months, hospital staff lost track of the child and its family. The reasons for this lapse were not disclosed.
When the infant was nearly two years old, researchers stated that hospital staff resumed contact with the baby and its "caretaker." This adult disclosed to healthcare providers that they had stopped giving ART to the baby at about 18 months of age. Again, the reasons for this were not disclosed.
Extensive virologic, immunologic and genetic testing was performed on the baby's blood. The reason for the genetic testing was to confirm that the baby was indeed the same infant that had been previously cared for at the hospital. At this point, the hospital laboratory's experimental single copy assay confirmed that the infant's viral load was 1 copy/ml. The baby is clinically well and at the time the results were reported at the conference has not taken ART for almost a year.
Points to Consider
It is premature to suggest that routine use of prolonged ART in HIV-infected babies born to HIV-positive mothers will cure the infants. Today most babies born to HIV-positive mothers are born in low- and middle-income countries. The reasons that some of these babies in those countries are born infected are that their mothers received limited or no prenatal care, had little or no access to ART and breast fed the babies. International agencies, local governments and NGOs are working hard to bring the rate of mother-to-child transmissions of HIV to zero.
In Canada and other high-income countries, the vast majority of HIV-positive women who become pregnant receive prenatal care and ART and give birth to healthy babies. There are, of course, cases where mothers in high-income countries may not receive prenatal care. The reasons for this are complex and vary from one woman to another but are usually related to one or more of the following factors:
By making the offer of a routine HIV test much more widely available, expanding health and addiction prevention and treatment services, prenatal care and other social services to populations in need, and engaging communities in strengthening their health, Canada, the U.S. and other high-income countries can help to bring an end to babies born with HIV.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
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