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No Longer Cured: HIV Relapse in "Mississippi Child" Raises New Questions

July 10, 2014

Undoubtedly, the biggest HIV story last year was the functional cure of an infant from Mississippi, after antiretroviral treatment was started within hours after her birth. The baby girl was on treatment for 18 months until being lost to follow-up, at which point the mother took her off treatment. Surprisingly, when the baby was returned to care five months later, she showed no traces of HIV despite no longer being on treatment. This continued for more than two years, with the child remaining off medications.

Unfortunately, earlier this month during a routine checkup, the child -- now almost 4 years old -- was suddenly found to have a detectable viral load of 16,750 copies/mL. Another test 72 hours later showed a viral load of 10,564 copies/mL, confirming that the child's HIV had rebounded, according to a news release from the U.S. National Institute of Allergy and Infectious Diseases (NIAID) issued on July 10.

Moreover, the child's CD4 count had decreased, and she had developed HIV antibodies, signaling active HIV replication. Based on these findings, the child was started on antiretroviral treatment again. She is currently tolerating the medications well with no side effects, and is showing a decreased viral load, according to the news release.

Genetic sequencing confirmed that the child's virus was indeed the same strain acquired from the mother. Hannah Gay, M.D., a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson, who has been the child's doctor since birth, will continue to monitor and provide care to the child, the release states.


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Impact

While this is unfortunate news, the focus now shifts to better understanding how the Mississippi child was able to maintain undetectable levels of HIV for more than two years without treatment, and also to explore what might be the keys to prolonging HIV remission in the absence of treatment.

At this year's CROI, we got news of a second child who was seemingly cured after a similar approach of commencing HIV treatment shortly after birth. The question now is whether this second child will also rebound. Certainly, after this update on the Mississippi child, doctors will continue to closely monitor the second child.

Additionally, this isn't the first case of relapse in patients who were seemingly cured. Two Boston patients initially showed no signs of HIV after receiving bone marrow transplants, but months after stopping treatment, the virus reemerged. We don't yet know why, nor do we know whether the mechanism behind the rebound is similar to that behind the Mississippi child's, but these are questions worth examining in future studies.

"Scientifically, this development reminds us that we still have much more to learn about the intricacies of HIV infection and where the virus hides in the body. The NIH [U.S. National Institutes of Health] remains committed to moving forward with research on a cure for HIV infection," said Anthony S. Fauci, M.D., NIAID director, in the NIAID statement.

"The case of the Mississippi child indicates that early antiretroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period. Now we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged even further," Fauci concluded.

Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.

Follow Warren on Twitter: @WarrenAtTheBody.


Copyright © 2014 Remedy Health Media, LLC. All rights reserved.



 
See Also
"Mississippi Baby" Now Has Detectable HIV, Researchers Find
NIH to Study Whether Infants Born With HIV Can Be Cured With Aggressive Therapy
New Approach to Reactivate Latent HIV Shows Promise
No Proof of New HIV Cure, Despite Headlines -- Here's What We Know
The Only Cases of HIV Cure or Remission
Beyond the Berlin Patient: How Researchers Are Now Trying to Cure More HIV-Positive People (Video)
What Would an HIV Cure Mean for You?

Reader Comments:

Comment by: Phil Keller (Sylvester, Ga) Mon., Oct. 13, 2014 at 10:09 pm UTC
It is unfortunate that the child did not remain undetectable, and cured. However, of my personal research, it is oknown that ANY HIV can lay dormant for as long as 5 + years. While it is sad, I do believe that HIV Specialist should be well informed of this if they are trained in this area of medical expertise. From my lay man's research, I believe that more research should have been done before it was actually considered being a "MISSISSIPPI CURE" child.
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Comment by: Sandy (Spokane, Wa) Sat., Sep. 20, 2014 at 3:15 pm UTC
Could the child have "caught" the virus from her mother? Could the child have been re- infected?
Reply to this comment


Comment by: Len (NYC) Sat., Sep. 20, 2014 at 8:26 am UTC
What happens when Ebola and HIV combine with other strains or even the flu or common cold and mutation happens! WE DON'T REALLY KNOW !
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Comment by: N (Kansas) Fri., Aug. 1, 2014 at 9:57 am UTC
How is it that they know this is a true relapse and not a new HIV infection received from contact with the mother?
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Comment by: Ongei David (South Sudan.) Sat., Jul. 26, 2014 at 4:08 am UTC
It's unfortunate that the relapse did occur. My unanswered quiz is 'during this period when the mother got lost.... how sure was it that the child was on care?' The quiz of proper adherence comes in....
Otherwise am pleased by TheBody.com for the updates we get. keep it up.
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Comment by: Grant Cobb (Ottawa, Ontario) Tue., Jul. 22, 2014 at 12:34 pm UTC
The capitalist culture of big pharma; makes me fear the child was infected on purpose. Who can know that the child was infected through breast milk or even on purpose.

She got lost to the medical system, there are many choices one can make, or is guided to make when money is involved.

My heart breaks every time there is a 'CURE' only to have it debunked days later ... I know the power of money, I'd hate to believe there is still no cure.

yet the pharmaceutical companies continue to rake in millions every day on overpriced medications with no end in sight ... sad for all of us.
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Comment by: maria (south africa) Thu., Jul. 17, 2014 at 4:52 pm UTC
Thank you very much for the latest update on hiv cure. Although there is still no imminent hope for the cure, we are very much relaxed that the present arvs manage hiv.

At least hiv is a chronic and manageable. Positive people live long and healthy life.
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Comment by: CAROLE OMITTO (KENYA) Sat., Jul. 12, 2014 at 2:09 am UTC
It is so unfortunate news, but not to relent,you have made positive strides in regard to HIV management, keep on with the good work, for your efforts are being appreciated by many worldwide.
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Comment by: Primo (Los Angeles, CA) Fri., Jul. 11, 2014 at 6:46 pm UTC
Now I am concerned about the Berlin's patient
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Comment by: happynurse (Cleveland, Ohio) Fri., Jul. 11, 2014 at 1:59 pm UTC
Thanks for providing this article, although the news wasn't particularly good. As Fauci says, we still have a long way to go...But I rely on the BodyPro to keep me up to date! Thanks again.
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