July 16, 2014
Initial results from the Canadian pediatric HIV research mentioned in a recent blog post were published in Clinical Infectious Diseases on June 9th. The paper notes that Canada's three pediatric HIV care institutions have a longstanding policy of administering triple drug antiretroviral therapy (ART) regimens to newborns considered at a high risk of HIV infection (either because the mother has detectable viral load at delivery or, in the absence of viral load results, if there is evidence of non-adherence to ART). Treatment is continued if HIV infection is subsequently confirmed. The researchers, inspired in part by the Mississippi baby case report (before the news of viral rebound emerged), searched their records for examples of children who had been started on ART within 72 hours of birth. A total of 136 were identified and, of those, 12 were confirmed to have acquired HIV infection. Four have since been maintained on ART with continuous viral load suppression; ages range from 2.5-7.5 years.
Consistent with other studies of early ART in infants, all four were found to lack detectable HIV-specific antibody and cellular immune responses, and displayed undetectable or extremely low levels of HIV DNA and RNA. In two of the children, tests for replication-competent virus were performed; in one case the result was negative and in the other 0.1 infectious units per million CD4 T cells were detected (the lowest level of detection possible with the assay). The researchers are scheduled to present an update on the cohort next week at the International AIDS Conference in Melbourne, during the "Challenges in Paediatrics" session on Tuesday July 22nd (abstract TUAB0206LB).
Regrettably, the notoriously unreliable media outlet The Daily Mail (often colloquially referred to as The Daily Fail) has already offered wildly misleading coverage of this research, with a headline on July 1st that read: "Three babies 'CURED' of HIV after being given revolutionary new vaccine." As is typical, the exciting-sounding but mistaken article rapidly proliferated on the web, being copied on multiple other sites and social media. After complaints, the Mail made a small and completely inadequate correction to the headline, removing the imaginary vaccine and instead offering: "Three babies 'CURED' of HIV after being given revolutionary new medical treatment in the first hours of their lives" (the reference to a vaccine persists in the URL and page header). A few paragraphs down, the article flatly contradicts its own headline with an eminently sensible quote from Dr. Sharon Lewin: "At the moment, the doctors do not know whether they are in fact cured. The only way they can tell is if they stop the anti-HIV drugs and see if it comes back." The importance of Lewin's point has, sadly, since been further emphasized by the news about the viral load rebound in the child in Mississippi.
The Canadian researchers themselves, in a separate presentation at the 23rd Annual Canadian Conference on HIV/AIDS Research in May, documented an example of viral load rebound after ART interruption in another of the 12 children identified in their analysis.
Although hopes of achieving a cure with early ART alone have now been diminished, studies like these remain essential for understanding the extent to which the HIV reservoir can potentially be reduced by early treatment, and for setting the stage for studies of interventions that might be able to target the residual amounts of virus for elimination.
Richard Jefferys is the coordinator of the Michael Palm HIV Basic Science, Vaccines & Prevention Project Weblog at the Treatment Action Group (TAG). The original blog post may be viewed here.
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