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Infant Cured of HIV, Hopes Raised



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Bloomberg reports:

The baby, whose identity has been kept anonymous, began a regimen of AIDS drugs about 30 hours after she was born at a rural Mississippi hospital, doctors said yesterday at a medical meeting in Atlanta. At 18 months, the mother took the child off the medication. With no signs of the virus for 10 months, the infant was deemed “functionally cured,” researchers said.

HIV treatments can hold the disease at bay, though stopping the drugs can be a death sentence since it allows infected cells secreted within the immune system to re-emerge, spreading the virus anew. Administering the mix of drugs right after birth may have stopped the virus from forming hidden reservoirs. If confirmed in further studies, the approach could help cure some of the 300,000 children infected each year with the AIDS virus.

“Some babies here in the U.S. and Western Europe, and an awful lot of babies in the developing world don’t have the opportunity for prevention,” said Hannah Gay, who treated the infant at the University of Mississippi in Jackson. “There would be scores of babies that would benefit if we can find a strategy for intervention that allows us to make this happen in other babies.”

Doctors reported the result at the Conference on Retroviruses and Opportunistic Infections, an annual gathering of more than 4,000 infectious disease researchers.

This development points to a hopeful way forward for children who contract HIV during pregnancy or around birth, although it may still not offer much hope for non-infant contractors of HIV. Mother-to-child transmission (MTCT) has been largely eliminated in the industrial world, but curing the virus in those who do end up getting it would still save lives, and the impact in the developing world could be huge.

Essentially, a pregnant mother who is known to be HIV-positive is treated with especially high doses of antiretrovirals, weakening the presence of the virus in her system and making her less likely to transmit the virus to her child via various bodily fluids. Because almost all HIV-positive patients in the West know their status and have access to such drugs already (and receive more intensive treatment around birth), MTCT is very rare in wealthy nations – according to Reuters, 100 to 200 American children per year are born with the virus, and the odds of passing on the virus here are around 1 or 2 percent. In Mississippi, because so many risk factors were president, the doctor immediately began treatment on the child with more drugs. Those drugs are toxic and highly taxing, so a physician will usually wait until it’s known that the infant has the virus, which can take weeks. It appears that aggressive immediate treatment of the infant with normal HIV drugs knocked out the virus for good even after it had been contracted. This seems like a possible treatment strategy where risks are high in a wealthy setting, but again, the odds there of an infant contracting the virus in the first place are pretty low (the most obvious implication is that more accurate and quicker testing is needed).

But such transmissions remain heartbreakingly common in the developing world — globally, hundreds of thousands of babies are born per year infected with HIV (infants sometimes acquire it via breast milk from an HIV-infected mother, too). Despite immense worldwide efforts to fight the HIV pandemic, many poor mothers still don’t know they are infected, don’t have regular access to antiretroviral drugs (ARVs) that fight the virus, or don’t even have access to a regimen of drugs around birth that can significantly reduce the likelihood of transmission. Without that dosage of drugs around birth (called PMTCT), odds of passing on the virus are as high as one-in-two; with the ARVs now available, the rate can be reduced to First World levels.

All of that gets to one interesting political point — for years, the twin goals of sexual tolerance and cost effectiveness meant that the West’s approach to he HIV/AIDS pandemic has been to hand out condoms, withhold judgment about risky behaviors, and watch Africans die. That began to change, essentially, when the United States, led by President Bush, began investing billions of dollars in treatment programs across the world, concentrated in Southern Africa. (The grudging acceptance by liberals’ favorite anti-colonial African leaders, such as Thabo Mbeki, that HIV drugs did work helped, too.) As with MTCT, any person who’s being treated with proper antiretrovirals has a much weaker presence of HIV in their system (what’s called a “viral load”), making them much less likely to pass the disease on to others. Thus, when the West finally committed to funding treatment programs for Africa (and other risky regions, such as the Caribbean), transmission rates started to drop, and millions of people got the added benefit of staying alive, too.

The relationship between viral load and likelihood of transmission is important in another way, too: HIV’s presence is much stronger in a person’s system in the few weeks following his contraction of the virus, making him magnitudes more likely to pass it on to a sexual partner during that time period. In fact, in the absence of other risk factors (such as other sexually transmitted diseases or an weakened immune system), the risk of passing on HIV after that initial period is low enough that an epidemic basically can’t be sustained. But concurrent partnerships, such as between one man and multiple women in his community or elsewhere, is so common in a variety of African contexts that partners often had the chance to pass on the virus during that key dangerous period. The liberal response to this problem was to accept this rotten, deadly culture, and encourage that it be conducted “safely.” The problem was that years of utterly blind condom distribution and sexual education barely raised safe-sex rates at all, and the virus flew across Africa, killing millions.

It wasn’t until the mid-2000s that, in view of some encouraging evidence from Uganda and other nations, dispensing with liberal taboos, a more comprehensive strategy was adopted by most global-health workers. That called for a threefold “ABC” (abstinence, be faithful, condoms) approach, which, combined with the U.S.’s offer of much greater investment in all levels of HIV/AIDS programming and increasingly effective and well-funded public-health programs in some African countries, has finally begun to make progress in the war on HIV/AIDS. (For a good summary of these issues, see this piece by Edward Green, a Harvard researcher who bravely and repeatedly has pointed out that responses to the pandemic have been driven by ideological considerations rather than evidence.)

So here is the good news that the Mississippi miracle just compounds: More and more HIV-positive mothers are getting tests and drugs (both around birth and long-term) every year, in large part thanks to the U.S.’s HIV/AIDS programs. In 2011, for instance, the well-known PEPFAR program provided almost 10 million tests for mothers, and provided preventative ARVs to 660,000 women, dramatically cutting the odds of their babies being born with HIV. The program has probably been one of the most successful humanitarian interventions in human history, and may some day be ranked on par with the elimination of small pox and polio (given the relative intractability of HIV/AIDS). The nature of the program has changed a lot in recent years, and funding has not been increased at the rate administrators and activists have demanded (for which they have excoriated President Obama), but it remains a huge program that’s still growing, and still saving lives at an unprecedented rate.

As an aside, if you wanted more discussion of AIDS treatment, the Reuters piece also explains that this is different from the one other instance of a person being cured of HIV, known as “the Berlin patient.” That man was simultaneously afflicted with HIV and with leukemia, and when he needed a bone-marrow transplant to treat the latter, his doctors sought out a transplant from a rare genetic subset of Caucasians (about 1 percent of the population) that have a natural resistance to HIV. He received a heavy treatment of drugs and radiation, and then the infusion of stem cells from the HIV-resistant donor, and the HIV virus never reemerged in his body. He was cured, and hasn’t been on HIV drugs for several years now. But this treatment regime isn’t really scalable — for one, the risks of bone-marrow transplants mean that it isn’t likely to reduce mortality among people diagnosed with HIV who don’t need the transplants otherwise. The search for a cure, then, continues.



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