Allison Shelley

March 04, 2013

A 2-year-old child born with human immunodeficiency virus (HIV) and treated with antiretroviral drugs in the first days of life has been functionally cured, investigators report.

The National Institutes of Health study found that the toddler no longer has detectable levels of the virus, despite not taking medication for 10 months.

"Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place," lead investigator Deborah Persaud, MD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, said in a news release.

The findings offer clues for potentially eliminating HIV infection in other children, Dr. Persaud told delegates attending the 20th Conference on Retroviruses and Opportunistic Infections in Atlanta, Georgia.

This is the first well-documented case of an HIV-infected child who appears to have been functionally cured. Before this, a single sterilizing cure had been reported.

The sterilizing case occurred in an HIV-positive man treated with a bone marrow transplant for leukemia. The bone marrow cells came from a donor with a rare genetic mutation of the white blood cells, which renders some people resistant to HIV; that benefit was transferred to the recipient.

In contrast to a sterilizing cure — a complete eradication of all viral traces from the body — a functional cure occurs when viral presence is so minimal that it remains undetectable with standard clinical testing.

Prompt antiviral therapy...may help infants clear the virus and achieve long-term remission.

The child in this case, born prematurely in July 2010, was delivered at 35 weeks to an HIV-infected mother in Mississippi who had not received antiretroviral medication or prenatal care.

Because of the high risk for exposure to HIV, the infant was started on liquid antiretroviral treatment at 30 hours of age, which consisted of a combination of 3 anti-HIV drugs — zidovudine, lamivudine, and nevirapine.

The newborn's HIV infection was confirmed with 2 blood samples and analyzed with highly sensitive polymerase chain reaction testing.

The baby was discharged from the hospital at 1 week of age and placed on liquid antiretroviral therapy, consisting of combination zidovudine, lamivudine, plus coformulated lopinavir–ritonavir, the standard regimen for treating HIV-infected infants in the United States.

Plasma viral load tests performed on blood from the baby during the first 3 weeks of life again indicated HIV infection. However, by day 29, the infant's viral load had fallen to less than 50 copies of HIV per milliliter of blood.

The prescribed antiretroviral treatment regimen was continued until January 2012, when the baby was 18 months of age.

Undetectable HIV Levels

In the fall of 2012, HIV was undetectable in blood samples — levels were below 20 copies/mL and there were no HIV-specific antibodies. Further testing revealed extremely low viral levels.

Today, the child continues to thrive without antiretroviral therapy, and no identifiable levels of HIV can be found using standard assays, said Dr. Persaud.

The child is under the medical care of Hannah Gay, MD, a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson.

Our next step is to find out if this is...something we can actually replicate in other high-risk newborns.

Dr. Persaud, working with Katherine Luzuriaga, MD, from the University of Massachusetts Medical School in Worcester, will continue to follow the case.

"Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns," Dr. Persaud explained.

The investigators are scheduled to sit down with Medscape Medical News later today in Atlanta. Our news team will have the full report this week, along with reaction from delegates attending the meeting.

"The reported result in this patient underscores an important concept for future validation," Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told Medscape Medical News. "The best way to either eliminate the virus or allow the immune system to suppress residual virus is to treat someone as early as possible after infection, so as not to allow a substantial reservoir of the virus to take hold," he explained.

This prevents the immune system from being severely damaged by the continual replication of virus for an extended period of time, he said. "The situation with a child born of an infected mother, where most of the infections are transmitted to the newborn at or around the time of delivery, provides an excellent opportunity to cure an infected baby. This approach deserves further study," Dr. Fauci noted.

This study was funded by the National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Foundation for AIDS Research. The investigators have disclosed no relevant financial relationships.

20th Conference on Retroviruses and Opportunistic Infections (CROI). Presented March 3, 2013.