Baby Cured of HIV Infection (cont.)
Eric S. Daar, MD
Eric S. Daar, MD
Dr. Daar received his undergraduate degree from UCLA and medical degree from Georgetown University School of Medicine. He completed an internship and residency in internal medicine at Cedars-Sinai Medical Center and his clinical and research fellowship in infectious diseases at Cedars-Sinai Medical Center and UCLA.
An argument made by the investigators against the possibility that infection did not actually occur is that it would have required substantial transfer of maternal blood, which had a viral load of ~2500 copies/mL, to result in the baby having the observed initial plasma viral load of ~20,000 copies/mL. In addition, the decay of virus over the first few weeks occurred gradually, at least partially mimicking that which is seen in infected individuals starting on antiretroviral therapy. Further support for the possibility that early treatment could result in a smaller reservoir with potential enhanced likelihood of virologic control after prolonged antiretroviral therapy comes from two other recently reported studies. One study included four other newborns started on combination therapy during the first weeks of life who were also shown to have very low levels of HIV in their blood, although treatment had not been discontinued to assess whether viral rebound would occur. The other was from a French group of adults treated during the first weeks of HIV infection. A subset of 14 had low levels of the HIV reservoir while on treatment, and upon discontinuation of therapy, showed little or no evidence of viral rebound.
Where do we go from here?
Based upon our experience in the field, I would suggest that the first thing we should do is take a few collective deep breaths and remind ourselves of the many past false starts resulting from case reports and case series. Next, we should take a few more deep breaths and think through what this new data may be telling us, look for opportunities to further study the phenomenon with existing patients, and design new clinical trials to systematically define how early treatment might be important in achieving a functional cure.
Last Editorial Review: 4/3/2013 6:12:53 PM