News that a second baby born with HIV appears to have been cleared of infection after early and aggressive treatment is further evidence that early therapy may be the key to achieving remission, said immunologist Katherine Luzuriaga, MD, professor of pediatrics and molecular medicine, who is working on both cases.
“Twenty years ago, I don’t think we would have thought we’d get to the point where we’d talk about a functional cure,” Dr. Luzuriaga said in a plenary talk delivered as part of the “Towards a Cure” Symposium at the Conference on Retroviruses and Opportunistic Infections in Boston, according to coverage in the Jackson, Miss., Clarion Ledger. “However, many years of research have led to the understanding that viral reservoirs, which serve as the barrier to cure, are laid down very early in infection, leading to the concept that initiating treatment within hours of birth will be necessary to eradicate infection.”
At the same conference last year, Luzuriaga and colleagues Hannah Gay, MD, from the University of Mississippi Medical Center, and Deborah Persaud, MD, of Johns Hopkins Children’s Center, announced the first case of a baby functionally cured of its HIV infection after receiving therapeutic antiretroviral treatment just 30 hours after birth. The child, born in Mississippi, was born to an HIV-infected mother who did not have prenatal care. The therapy continued until about 18 months of age, when the child was lost to follow-up and off the drugs. Months later, the child returned to the hospital and researchers found no evidence of viral rebound. Details on the case were published last October in the New England Journal of Medicine.
Luzuriaga and colleagues report that the child remains in remission, and off drugs, for almost two years. Meanwhile, a baby born in Long Beach to an HIV-infected mother who was not taking her medication was given the same therapy, beginning at four hours of age. Nine months later, the team reports that this baby, too, appears clear of the virus. The child has not been taken off therapy, but doctors are trying to asceratin when they may do so.
New research is focused on replicating the results in other newborns with the virus.
“Intensive analyses of these two cases, along with anaylses conducted within a soon-to-open, NIH-sponsored clinical trial of therapy initiated with in 48 hours of birth will undoubtedly yield information on viral reservoirs that will help us to determine the optimal length of treatment in these children that may lead to remission.” Luzuriaga said. “Efforts are also ongoing to better understand viral reservoirs in children who started treatement later in life, with the hopes of crafting approaches that could spare them a lifetime of therapy. But even as as we push the concept of curing children, we have to continue our focus on preventing new infections in kids.”
Read full coverage of the research below:
Doctors hope for cure in a 2nd baby born with HIV
Worcester Telegram & Gazette – March 6, 2014
Doctors: 2nd baby with HIV successfully treated
Clarion Ledger – March 5, 2014
Researchers Are Working On ‘Curing’ Up To 60 HIV-Positive Babies
Think Progress – March 6, 2014
Early treatment is found to cure HIV in second baby
New York Times – March 5, 2014
Doctors hope for a cure in a 2nd baby born with HIV
Boston Globe – March 5, 2014
Related links on UMassMedNow:
Discovery prompts new hope for pediatric HIV cure at UMMS
Researchers describe first 'functional HIV cure' in an infant
Early HIV treatment aids long-term viral suppression in teens