HIV Baby Taken Off Antiretrovirals in Remission at Age 3

Researchers Now Reporting Second Case

Marcia Frellick

Disclosures

March 05, 2014

BOSTON — The Mississippi infant born with HIV who made headlines around the world last year when physicians announced she was functionally cured 10 months after stopping combination antiretroviral therapy still has no detectable levels of the virus at age 3, researchers report.

The baby has undetectable plasma viremia (<20 copies/mL) and normal CD4+ and CD8+ T-cell counts at 39 months of age — 21 months after stopping antiretroviral therapy, explained Deborah Persaud, MD, from Johns Hopkins University School of Medicine in Baltimore.

"The child remains in remission and there's no replication combinant T-cell reservoir detectable to date," she reported here at the 2014 Conference on Retroviruses and Opportunistic Infections. "This supports our hypothesis that very early treatment may prevent the formation of reservoirs that currently preclude a cure."

Dr. Persaud introduced the case of a second baby, in Los Angeles County, who started receiving therapy 4 hours after birth. At 8 months, that baby — whose sex has not been disclosed — no longer has detectable levels of the virus.

Four hours after the birth of this second baby, positive status was confirmed with peripheral blood HIV DNA polymerase chain reaction; 36 hours after birth, HIV RNA levels were determined to be 217 copies/mL. By the sixth day of life, HIV DNA testing was negative. The baby was born to a mother with a high viral load who had been prescribed antiretrovirals but had not taken them consistently.

Second Case

"It's important for the field to identify strategies to manage these very early treatments in infants," Dr. Persaud said.

In 2 to 3 months, clinical trials will begin domestically and internationally to test the effects of very early treatment in HIV-infected infants, she said.

Although the 2 cases are different, they share a positive message, said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.

"I don't think we can say much about the second baby because they have not discontinued antiretroviral therapy," he told Medscape Medical News. However, "a very important component of any attempt to ultimately get people off therapy is to treat them as early as possible to decrease the size of the ultimate reservoir. The longer you have the virus, the greater the chance of having a substantial reservoir," Dr. Fauci explained.

 
This strongly suggests that they will be able to do the same thing with this baby that they did with the first.

When treatment is started at the time of infection, the chances of very rapidly suppressing virus replications are very good, he explained. With babies, you know almost exactly when they were infected — usually at birth. Adults might not be able to pinpoint the day or even month of infection.

He noted that although prospective studies will be done, retrospective studies will look back at babies who were treated extremely early. "We may have inadvertently cured some babies without even realizing it, merely with the normal practice of pediatric medicine," he speculated.

Short of knowing the outcome of the second child, because therapy continues, it is a good sign that the virus has been reduced to undetectable levels, Dr. Fauci said. "This strongly suggests that they will be able to do the same thing with this baby that they did with the first."

Dr. Persaud and Dr. Fauci have disclosed no relevant financial relationships.

2014 Conference on Retroviruses and Opportunistic Infections (CROI). Presented March 5, 2014.

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