The remarkable case of a baby being cured of HIV infection in the United States using readily available drugs has raised new hope for eradicating the infection in infants worldwide, but scientists say it will take a lot more research and much more sensitive diagnostics before this hope becomes a reality.
In a medical first for an infant, the Mississippi toddler was born in July 2010 infected with HIV, treated within 30 hours of delivery with aggressive HIV therapy, which continued for 18 months. She is now considered cured of her infection, a team of researchers led by Dr. Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, said in a news conference at the Conference on Retroviruses and Opportunistic Infections in Atlanta on Sunday.
"From a clinical perspective, this means that if you can get an infected baby on to antiretroviral drugs immediately after delivery, it's going to be possible to prevent or reverse the infection - essentially cure the baby," said Dr. Steven Deeks, an HIV/AIDS researcher at the University of California at San Francisco who is attending the conference, where the case was presented to researchers on Monday.
Deeks and others hailed the findings as a great advance in the search for a cure in babies born infected with HIV. But the researchers said they also suggest the need for better ways to diagnose HIV infection, a process that typically takes up to six weeks.
"This could have a profound effect on how we approach babies born to HIV-infected moms," Deeks said.
Treatment of HIV-infected mothers before delivery is the best way to prevent HIV infection of infants, experts say, but even in resource-rich countries such as the United States, 100 to 200 babies are born each year infected with HIV, the virus that causes AIDS, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
Worldwide, especially in developing countries, as many as 1,000 babies are born infected each day. For these children, the findings could have a major impact on the "terrible burden of HIV infection throughout the world," Fauci said.
Michel Sidibé, executive director of the Joint United Nations Programme on HIV/AIDS, known as UNAIDS, said the news "gives us great hope that a cure for HIV in children is possible," but it also underscores the need for research and innovation, "especially in the area of early diagnostics."
Fauci said the child's case was an important "proof of concept," but he cautioned that it was only one case and it needs to be further validated.
"The real question is will this be broadly applicable to other infants?" he said.
Fauci said there is a risk that without better diagnostics, children who were never infected in the first place could be exposed to toxic drugs with very early treatment.
In the case of the Mississippi girl, Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson, made the call to treat the child with HIV drugs even before her infection was confirmed because she believed the child was at such great risk of infection. Had she been wrong, the therapy would have been stopped.
"Since the mother had really been at such high risk of transmitting to the baby, they decided to treat on square one," said Fauci, as opposed to giving the child a lower, preventative dose of drugs until test results confirm an infection.
"The approach of treating really, really early needs to be pursued," he said. "When we get better diagnostics where we can tell within the first day or so whether the baby is infected, an approach like this looks like it might be a reasonable thing to pursue with the appropriate clinical trials."
Fauci said it is not time to change treatment protocols for infants who are born infected. "It's a single case. We've got to be careful about that."
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